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PubMed1983

Effect on drug costs of implementing decentralized drug distribution.

The drug costs associated with a centralized drug-distribution system were compared with those of a newly implemented decentralized unit dose and i.v. admixture system in a university teaching hospital. Three months before and three months after implementation and stabilization of the new drug-distribution system, the mean drug cost per patient day was determined for each of 22 nursing stations. Variations in drug use were monitored to eliminate the influence of patient mix or treatment protocol. Data from 2 of the 22 nursing stations were excluded from analysis because of large variations in drug use. Twelve nursing stations demonstrated lower drug costs per patient day with the new drug-distribution system. Overall, an 18% reduction in drug costs per patient day was achieved. In this hospital, a decentralized drug-distribution system was associated with lower drug costs than the traditional distribution system.

Costs and Cost Analysis↗
PubMed1982

[Experience of the National School of Public Health of Rio de Janeiro with decentralization of the public health course].

This work describes the process of decentralizing the course in public health at the National School of Public Health (ENSP) in Rio de Janeiro. The authors examine different stages of the organization and administration of parallel courses which, from 1975 to 1980, expanded from three to 15 States in order to meet the need for educating public health professionals in different geographic areas. They also describe the system of evaluating and financing the courses, and conclude that the training of 1,643 professionals in six years and the growing interest and participation of the States, fully justify the decentralization effort.

Brazil↗
PubMed1981

Cost justification of decentralized pharmaceutical services for the emergency room.

The implementation of decentralized pharmaceutical services in an emergency room (ER) is described, with emphasis on cost justification. As part of an overall hospital goal of improving patient-care services in the ER the pharmacy department identified its role in the plan. The objectives of the pharmacy included providing faster prescription-filling services with more patient education, to increase the number of ER prescription filled in-house, to improve drug control and accountability of floor stock medications in the ER, and to expand clinical services inthe ER. To do this, a satellite pharmacy was established in the ER. Implementation costs for the first year of operation were estimated at +122,875; of this represented a transfer of inventory from other pharmacy areas, and +62,900 represented personnel cost that were also transferred from other areas. Actual costs of operation were less; the actual expense was +103,557. The drug and supply cost were +48,186; inventory turnover rate was 8.8. The ER pharmacy had a +48,901 margin of revenue over expenses. The ratio of ER prescriptions filled to discharges increased, indicating an increase in prescription filling volume. Despite a decrease in the number of ER visits, the number of prescriptions filled increased 14%. Decentralized ER pharmaceutical services in this institution met the outlined objectives on a cost-effective basis.

Costs and Cost Analysis↗
PubMed1994

[The decentralization and municipalization of health services in Säo Paulo, Brazil].

The health system in Brazil has undergone profound changes since the 1980s. In the state of São Paulo, the processes of decentralization to the municipio and regional levels, as well as integration of health services, began in 1983. This study describes the strategies adopted by the Ministry of Health of the state of São Paulo to implement these processes and create 65 regional health offices, and discusses the role of these offices in the new unified health system. It is concluded that decentralization has resulted in increased local government participation in financing the health system, that production of medical and community health services has grown, and that health indicators have improved.

Brazil↗
PubMed1994

Decentralization or centralization: striking a balance.

An Executive Vice President for Nursing can provide the necessary link to meet diverse clinical demands when encountering centralization--decentralization decisions. Centralized communication links hospital departments giving nurses a unified voice. Decentralization acknowledges the need for diversity and achieves the right balance of uniformity through a responsive communications network.

Centralized Hospital Services↗
PubMedDate not supplied

Decentralization of the staff development department in home care.

An easy transition to home care and improved quality of orientation are important factors for home care agencies considering decentralization of the staff development department. A Visiting Nurse Association found that the positive advantages of decentralization outweighed the initial adjustment problems.

Community Health Nursing↗
PubMedDate not supplied

Decentralization and the nurse educator: research, responsibilities, and barriers.

Decentralization is increasingly used in departments of nursing to achieve such outcomes as cost containment, job satisfaction, and improved patient care. Because decentralization is considered invaluable in today's rapidly changing health care environment, nurse educators must be knowledgeable regarding its principles and barriers. Their educational role and their support of staff during the transition period are critical to successful implementation.

Decision Making, Organizational↗
PubMed1996

Automated decentralized pharmacy dispensing systems.

Automated decentralized pharmacy dispensing systems (ADPDSs) are medication management systems that allow hospitals to store and dispense drugs near the point of use. These systems, which can be compared with the automated teller machines used by banks, provide nurses with ready access to medications while maintaining tight control of drug distribution. In this study, we evaluated three ADPDSs from two suppliers, focusing on whether these systems can store and dispense drugs in a safe, secure, and effective manner. When rating the systems, we considered their applicability to two different implementation schemes: The use of a system with a pharmacy profile interface. This feature broadens the capabilities of the system by allowing more information to be provided at the dispensing cabinet and by providing better integration of the information from this cabinet with the pharmacy's information system. Two of the evaluated systems have this feature and were rated Acceptable. The use of a system without a pharmacy profile interface. We rated all three of the evaluated systems Acceptable for such implementations. To decide which scheme is most appropriate for a particular hospital, the facility will need to determine both how it intends to use the ADPDS and what it hopes to achieve by implementing the system. By performing this type of analysis, the facility can then determine which ADPDS features and capabilities are needed to accomplish its goals. To help facilities make these decisions, we have provided an Equipment Management Guide, "Improving the Drug Distribution Process-Do You Need an Automated Decentralized Pharmacy Dispensing System?," which precedes this Evaluation. In addition, readers unfamiliar with the roles of both the pharmacy and the pharmacist within the hospital can refer to the Primer, "Functions of a Hospital Pharmacy," also published in this issue.

Automation↗
PubMed1977

Centralized vs. decentralized child mental health services.

One of the basic tenets of the Community Mental Health Center movement is that services should be provided in the consumers' community. Various centers across the country have attempted to do this in either a centralized or decentralized fashion. Historically, most health services have been provided centrally, a good example being the traditional general hospital with its centralized medical services. Over the years, some of these services have become decentralized to take the form of local health centers, health maintenance organizations, community clinics, etc, and now various large mental health centers are also being broken down into smaller community units. An example of each type of mental health facility is delineated here.

Age Factors↗
PubMed1997

A decentralized, community-based design for statewide immunization registries in Minnesota.

Incomplete immunization records and an increasingly complex immunization schedule make it difficult for parents and providers to know what shots their children or clients need. Complete and accurate immunization records are needed for day care, sports, camp, and school, but this is difficult--especially when previous immunizations have been received at different clinics. Population-based immunization registries help make complete and accurate records more easily available to parents and health care providers. Registries foster the timely sending of reminder notices for children who are due for immunizations and make it possible for providers to quickly assess immunization rates in their clinic. Public health officials use registries to determine immunization rates, to identify pockets of need where immunization rates are low and to target resources. In Minnesota, over 85% of immunizations are delivered in the private sector. Minnesota is also extensively covered by managed care organizations with an estimated 75% of the total population enrolled in some type of managed care. Strong local community public health agencies in each county also drive local solutions to community needs. These factors and others led to a de-centralized approach to the implementation of registries. The "Minnesota Model" is based on the development of community-based registries which link together local clinics, hospitals, health plans, public health departments, and schools in each region. Each community-based registry is designed to link to a state hub. This decentralized open architecture design is based on standards for data, not hardware or software. The building begins, not by implementing a state registry into which all immunizations are entered, but at the community level. Currently, 38% of Minnesota counties (representing 52% of statewide births) are involved in implementing a community-based registry, and 53% (representing 43% of statewide births) have initiated discussions with private providers. Only 9% of counties (5% of statewide births) have no current registry activity. This paper describes the steps which have been taken towards developing a decentralized statewide immunization information system for Minnesota, based on recommendations put forth by The State Immunization Practices Task Force Work Group on Immunization Registries.

Child↗
PubMed1998

Decentralizing unit coordinator services.

Restructuring unit coordinator/unit clerk services by decentralizing this staff and having them report directly to nurse managers can totally integrate them into the functions and activities of a patient-centered team. This article describes how nurse managers can evaluate the feasibility of decentralizing unit coordinators in their own institutions.

Administrative Personnel↗
PubMed1990

Population decentralization policies: the experience of Taiwan.

"Social and economic policies and programs adopted by the government of Taiwan have slowed the pace of population concentration and prevented the highly concentrated distribution of population experienced by many developing countries. After presenting a brief analysis of Taiwan's population growth and distribution during the past three decades, this text examines the policies and programs credited with having curbed population concentration. They include both spatial development policies established for the purpose of decentralizing the population and its economic activities, and development policies that, although not designed expressly to curb population concentration, have had such an effect."

Asia↗
PubMed2005

Effect of decentration of wavefront-corrected intraocular lenses on the higher-order aberrations of the eye.

OBJECTIVE: To evaluate the theoretical effect of decentration of aspherical intraocular lenses (IOLs) and wavefront-corrected IOLs up to the sixth order on higher-order aberrations (HOAs) (third through sixth order) of the eye. METHODS: An aspherical IOL with HOAs of fourth-order spherical aberrations only (-0.287 microm with a 6-mm pupil) and a wavefront-corrected IOL with HOAs of equal magnitude and opposite from the corneal HOAs were created and laterally shifted up to 1 mm to simulate decentered IOLs. The residual HOAs for pupils of 3 to 6 mm were calculated by combining the HOAs from the cornea and the decentered IOL. Based on the residual HOAs, optical quality was rated by 3 criteria: the Marechal criterion, a diffraction-limited optical system with an aberration less than lambda/14; P(10), the lower 10th percentile of the corneal HOAs in this study group; and decreased HOA, residual ocular HOAs less than the corresponding corneal HOAs. RESULTS: Simulated implantation of the aspherical IOLs and wavefront-corrected IOLs was performed in 154 eyes of 94 patients aged 40 to 80 years. For a centered aspherical IOL and a 6-mm pupil, no eyes met the Marechal criterion, and the P(10) and decreased-HOA criteria were met by 46% and 93% of eyes, respectively. For a 6-mm pupil, the required centration was 0.47 mm to meet the decreased-HOA criterion in 50% of eyes. With a wavefront-corrected IOL and a 6-mm pupil, the centrations required to meet the criteria for 90% of eyes were 0.04 mm for the Marechal criterion, 0.36 mm for P(10), and 0.48 mm for the decreased-HOA criterion. CONCLUSION: Excellent centration is required to maximize the visual outcome of wavefront-corrected IOLs. CLINICAL RELEVANCE: With current surgical techniques, implantation of aspherical IOLs and wavefront-corrected IOLs will reduce total ocular HOAs below corneal HOAs in approximately 45% and 86% of eyes (6-mm pupil), respectively.

Adult↗
PubMed2006

Management of patients with biliary atresia in France: results of a decentralized policy 1986-2002.

This study analyzed the results of the decentralized management of biliary atresia (BA) in France, where an improved collaboration between centers has been promoted since 1997. Results were compared to those obtained in England and Wales, where BA patients have been centralized in three designated centers since 1999. According to their birth dates, BA patients were divided into two cohorts: cohort A, with patients born between 1986 and 1996, had 472 patients; and cohort B, with patients born between 1997 and 2002, had 271 patients. Survival rates were calculated according to the Kaplan-Meier method and compared by using the log rank test and the Cox model. Four-year overall BA patient survival was 73.6% (95% CI 69.5%-77.7%) and 87.1% (CI 82.6%-91.6%) in cohorts A and B, respectively (P < .001). Median age at time of the Kasai operation was 61 and 57 days in cohorts A and B, respectively (NS). Four-year survival with native liver after the Kasai operation was 40.1% and 42.7% in cohorts A and B, respectively (NS): 33.9% (cohort A) and 33.4% (cohort B) in the centers with two or fewer caseloads a year, 30.9% (cohort A) and 44.5% (cohort B) in the centers with 3-5 cases/year, 47.8% (cohort A) and 47.7% (cohort B) in the center with more than 20 caseloads a year. In cohorts A and B, 74 (15.7%) and 19 (7%) patients, respectively, died without liver transplantation (LT). Four-year survival after LT was 75.1% and 88.8% in cohorts A and B, respectively (P = .006). In conclusion, BA patients currently have the same chance of survival in France as in England and Wales. The early success rate of the Kasai operation remains inferior in the centers with limited caseloads in France, leading to a greater need for LTs in infancy and early childhood.

Adolescent↗
PubMedDate not supplied

Decentralization of management responsibility: the case of Danish hospitals.

This article examines a specific management reform at three hospitals in a Danish county. Management reform at the hospital level implies a decentralization of responsibility and power to the departmental level. Along with increased responsibility and power, departments get the message: keep your budgets and keep your output level. This preliminary analysis indicates that departmental budgets can be a way of containing costs in clinical departments. Non-staff expenditures especially are subjected to reductions. The system still seems to 'favour' doctors and nurses, but less than in a system with traditional budgetary institutions. The behaviour of the top-management teams shows that the output constraint is not seriously meant. Departments are allowed to reduce capacity, with declining output, with the knowledge of the top-management team. The declining output makes it easier to departments ceteris paribus to keep within their budgets. And that makes it easier for the top-management team to keep the overall hospital budget. The obligation to keep the overall hospital budget is thus an important criterion of success in the eyes of the political masters of hospitals.

Budgets↗
PubMedDate not supplied

Working in a decentralized system: a threat to health workers' respect and survival in Uganda.

This article contributes to the sparse empirical material on the position of health workers within health sector reform. Using qualitative data gathered in 1999, it shows how staff at rural health units in Tororo and Busia Districts experienced the reforms during the first 5 years of decentralization in Uganda. The analysis builds on a framework proposed by Franco et al. to examine the relation between health sector reform and health worker motivation. However, it diverges from their objective description of the factors determining motivation, giving more emphasis to the subjective perspective of the health workers. The categorical distinction between organizational and cultural/community factors was less relevant for them as actors. Two themes cross-cut their lives inside and outside the health facilities: professional identity, which entailed recognition by both the organization and members of the community; and 'survival strategies', which were necessitated by the desire to maintain a status and lifestyle befitting a professional. Reform weakened workers' positions as professionals and hindered facility-based 'survival strategies' that helped them get by on poor salaries. With an overall fall in remuneration, they were more motivated than ever to establish supplementary sources of income outside the formal government health care system.

Attitude of Health Personnel↗
PubMedDate not supplied

Key issues relating to decentralization at the provincial level of health management in Cambodia.

The following study was conducted as part of a review of management systems at a Provincial Health Department (Kampong Cham Province) and a National Health Programme (National Immunization Program) in 2002-2003 in Cambodia. The aim of this paper is to identify, analyse and recommend those management system factors that are critical to the success of health management performance, with a particular focus on provincial management. The review has identified critical success factors associated with health management performance at the sub-national level that include a stronger role for effective human resource management in health sector reform, elevation of the status of planning in senior level management, and the development of a more comprehensive and transparent finance system. These success factors will position the provincial level of health management to respond more effectively to the reform challenges of administrative de-concentration and political decentralization that are currently underway across a range of government sectors in Cambodia.

Cambodia↗
PubMed2000

A decentralized multichannel length transformation algorithm and its parallel implementation for real-time ECG monitoring.

Multichannel algorithms have been developed for more accurate analysis of electrocardiograms (ECGs). Their benefit is the ability to use the information contained in all simultaneously acquired channels. In this paper we present a multichannel version of a nonsyntactic algorithm, based on length transformation. The proposed algorithm uses a decentralized schema for combining the results derived from each individual lead, instead of a global/centralized one (a spatial vector approach). Its performance was evaluated using the CSE database and real ECGs acquired by a 12-lead cardiograph. The results are also compared with previous-single-channel and multichannel-versions of the algorithm, showing a better performance. Since a multichannel algorithm is always a time-consuming task, it is rarely used in real-time monitoring systems. Motivated by this observation, we designed a parallel implementation of the proposed algorithm and tested its ability to be used in such systems.

Algorithms↗