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PubMed2006

A resource-based view of partnership strategies in health care organizations.

The distribution of management structures in health care has been shifting from independent ownership to interorganizational relationships with other firms. A shortage of resources has been cited as one cause for such collaboration among health care entities. The resource- based view of the firm suggests that organizations differentiate between strategic alliances and acquisition strategies based on a firm's internal resources and the types of resources a potential partner organization possesses. This paper provides a review of the literature using the resource-based theory of the firm to understand what conditions foster different types of health care partnerships. A model of partnership alliances using the resource-based view is presented, strategic linkages are presented, managerial implications are outlined, and directions for future research are given.

Cooperative Behavior↗
PubMed1991

Patterns of resource consumption in medical intensive care.

Intensive care is being scrutinized as a major factor in increasing health care costs. We examined 404 consecutive admissions to the medical ICUs at a university medical center to study patterns of consumption of ICU resources and the proportion of resources used by patients admitted for monitoring only. We found a skewed distribution of ICU resource consumption, with the "high-cost" 8 percent using as many ICU resources as the "low-cost" 92 percent. Forty-one percent of admissions did not receive acute ICU treatments, but these admissions consumed less than 10 percent of ICU resources. Reducing the number of patients admitted for monitoring will have a relatively small impact on hospital charges. Since over 70 percent of the high-cost patients died, improved understanding of prognosis and better physician-patient communication may substantially reduce the proportion of critical care resources expended on futile treatment.

Academic Medical Centers↗
PubMed2002

Small-scale fisheries, population dynamics, and resource use in Africa: the case of Moree, Ghana.

We consider population dynamics and sustainable use and development of fishery resources in Moree, a small-scale fishing and coastal community of 20,000 people in the Central Region of Ghana near Cape Coast. Moree suggests that relationships between population dynamics and fishery resources are more complex than the concept of Malthusian overfishing implies. Reasons include changing biophysical characteristics of the upwelling system along the coast of West Africa; qualitative as well as quantitative changes in fishing activity throughout the year; the market nature of fishing activity and nonlocal demands for fish; regular fishery migration; and institutions regulating fishery resource access at home and at migration destinations. Population and resource relationships in Moree may be the effects of fishery resource and economic changes on migration rather than population pressure on fishery resources. Fisheries management policies must take into account processes that lie beyond the influence of local fishermen.

Animals↗
PubMed2005

Hospital resource utilization for primary and revision total hip arthroplasty.

BACKGROUND: Previous reports have suggested that hospital resource utilization for revision total hip arthroplasty is substantially higher than that for primary total hip arthroplasty. However, current United States Medicare hospital-reimbursement policy does not distinguish between the two procedures. The purpose of this study was to compare primary and revision total hip arthroplasties with regard to actual hospital resource utilization and to identify clinical and demographic factors that are predictive of higher resource utilization associated with these procedures. METHODS: We evaluated the clinical, demographic, and economic data associated with 491 consecutive unilateral primary or revision total hip arthroplasties performed by two surgeons at a single institution between January 2000 and December 2002. The distributions of various demographic, clinical, and utilization characteristics were compared between the two types of arthroplasty procedures, and multivariable linear regression techniques were used to determine independent patient characteristics that were predictive of higher costs for both the primary and the revision procedures. RESULTS: The mean total hospital cost was $31,341 for the revision procedures compared with $24,170 for the primary procedures (p < 0.0001). The mean operative time was 41% longer for the revisions than for the primary procedures (4.5 hours compared with 3.2 hours, p < 0.0001), the mean estimated blood loss was 160% higher (1348 mL compared with 518 mL, p < 0.0001), the mean complication rate was 32% higher (29% compared with 22%, p = 0.072), and the mean length of the hospital stay was 16% longer (6.5 days compared with 5.6 days, p = 0.0005). A higher severity-of-illness score (a measure of preoperative medical health) was predictive of higher resource utilization for both primary and revision arthroplasty even after adjustment for other factors. Preoperative femoral and ace-tabular bone loss and a diagnosis of periprosthetic fracture were predictive of higher resource utilization associated with revision procedures. CONCLUSIONS: At one institution, hospital resource utilization for revision total hip arthroplasty was found to be significantly higher than that for primary arthroplasty. This information is not reflected by current United States Medicare hospital reimbursement, which is the same for all lower-extremity arthroplasty procedures, regardless of the diagnosis, the complexity of the procedure, or the patient's baseline medical health. If these findings are generalizable to other institutions, appropriate reimbursement formulas should be developed to accurately reflect the true costs of caring for patients with a failed total hip arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2003

Resource utilisation and cost analysis of memantine in patients with moderate to severe Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is a devastating illness that causes enormous emotional stress to affected families and is associated with substantial medical and nonmedical costs. OBJECTIVE: To determine the effects of 28 weeks of memantine treatment for patients with AD on resource utilisation and costs. STUDY DESIGN AND METHODS: Multicentre, prospective, double-blind, randomised, placebo-controlled clinical trial performed in the US. The Wilcoxon-Mann-Whitney test was used to examine the resource utilisation variables and logistic regression models were used for multivariate resource utilisation analyses. Analysis of covariance (ANCOVA) models (log and non-log) were computed to examine costs from a societal perspective. All costs were calculated in 1999 US dollars. STUDY POPULATION: Outpatients with moderate to severe AD. Overall, 252 patients received randomised treatment, and 166 patients (placebo n = 76, memantine n = 90) formed the treated-per-protocol (TPP) subset for the health economic analyses, on which the main cost analysis was based. MAIN OUTCOME MEASURE: Resource Utilisation in Dementia (RUD) scale, measuring patient and caregiver resource utilisation, and various sources for cost calculations. RESULTS: Controlling for baseline differences between the groups, significantly less caregiver time was needed for patients receiving memantine than for those receiving placebo (difference 51.5 hours per month; 95% CI -95.27, -7.17; p = 0.02). Analysis of residential status also favoured memantine: time to institutionalisation (p = 0.052) and institutionalisation at week 28 (p = 0.04 with the chi-square test). Total costs from a societal perspective were lower in the memantine group (difference dollars US 1089.74/month [non-overlapping 95% CI for treatment difference -1954.90, -224.58]; p = 0.01). The main differences between the groups were total caregiver costs (dollars US-823.77/month; p = 0.03) and direct nonmedical costs (dollars US-430.84/month; p = 0.07) favouring memantine treatment. Patient direct medical costs were higher in the memantine group (p < 0.01), mainly due to the cost of memantine. CONCLUSION: Resource utilisation and total health costs were lower in the memantine group than the placebo group. The results suggest that memantine treatment of patients with moderate to severe AD is cost saving from a societal perspective.

Activities of Daily Living↗
PubMedDate not supplied

Making tough resource decisions. A process for considering both values and costs.

Effective resource management involves prospective decision making, including setting priorities. This enables healthcare facilities to provide services that are consistent with institutional commitments and, under some circumstances, to limit or deny services that are inconsistent with those commitments. The challenge is to apply explicit moral analysis to resource allocation efforts to ensure that facilities are treating patients consistently and fairly. Not only are allocation decisions unavoidable, they also can promote holistic, socially responsible medical practice. But current mechanisms, which are largely hidden from view and informal, can negatively affect important relationships with constituents. The just allocation of our precious healthcare resources rests on values that can either conflict with or complement one another. The core values in resource management include respect for persons, professional integrity, due process, informed consent, stewardship, and the common good. An interdisciplinary team of providers should oversee an ongoing review of resource management mechanisms. The group should meet regularly to look at how the mechanism works, what its goals are, what unit of care it evaluates, and what measurements are used to reach the goals. The measures might include severity of illness, effectiveness, cost, and social factors. Examining questions related to each of these areas can help the group determine whether an existing or proposed resource management mechanism is morally defensible.

Aged↗
PubMed2000

Identification of resource use and associated costs for viral meningitis.

PURPOSE: This study involved identifying resource use and assigning monetary value to the diagnostic work-up and management of viral meningitis. METHODOLOGY: Using a previously established decision analytic framework, various resources were identified as part of routine management of viral meningitis. Secondary database analyses were used to quantify resources and assign a monetary value as a part of routine management of viral meningitis requiring use of the resource units identified in the decision analytic framework. Discharge data sources from the states of California, Florida, and Illinois, and Medicaid data sources from the state of Pennsylvania, were used for the purpose of analysis. PRINCIPAL FINDINGS: Physician visits, emergency room visits, hospital admissions, procedures, and medications were identified as the major resource used. Lumbar punctures, CT scans, and antibiotics were identified as the major procedures and medications utilized. No significant difference was found in the major resources used between the states' discharge data and the Medicaid data sources. The mean total charges for patient admissions with CT scans were significantly higher than for patient admissions without CT scans ($11,531.80 vs $7,841.30, P < 0.05). The mean lengths of stay for patients with CT scan were significantly higher than for patient admissions without CT scans (4.71 days vs. 3.88 days, P < 0.05). The patient readmission rate was 10.7 percent, while the readmission rate for episodes with more than one hospitalization was 11.1 percent. The mean charge associated with readmission was $12,200.

Decision Support Systems, Clinical↗
PubMed2002

Health promoting behaviors, quality of life, and hospital resource utilization of patients receiving kidney transplants.

Despite the value of kidney transplantation for patients with renal failure, transplantation is sometimes accompanied by untoward consequences and considerable resource utilization. The identification of modifiable factors contributing to resource utilization is, therefore, important. This exploratory study of kidney transplant patients had two purposes: (a) to describe health-promoting behaviors and health-related quality of life (HRQOL) pretransplant and hospital resource utilization posttransplant and (b) to investigate relationships between these and other variables. Subjects were 44 patients who (before transplantation) completed the Health-Promoting Lifestyle Profile (HPLP) to quantify health-promoting behavior and the Medical Outcome Study Short Form (SF)-36 to measure HRQOL. Hospital resource utilization was characterized using transplant length of stay and charges and posttransplant emergency department visits, readmissions, and charges. The HPLP scores of the subjects were similar to those reported for middle-aged adults and patients with other diseases. The SF-36 subscale and summary scores were lower than those reported for the general population. Hospital resource utilization varied widely. Significant correlations were found between 52.9% of the HPLP and SF-36 scores. However, no HPLP score correlated significantly with any utilization measure. Of the SF-36 measures, only vitality correlated significantly with most utilization measures (greater vitality was associated with less posttransplant utilization). While many aspects of health-promoting behavior and HRQOL are related before transplant, neither HPLP, SF-36, nor any other measured variable strongly and consistently predicted hospital resource utilization.

Connecticut↗
PubMed2002

Water pricing towards sustainability of water resources: a case study in Beijing.

The role of water pricing for managing water resources is widely recognized in many areas of the world because of the increasing scarcity of water resources, a high competition between water uses and environmental degradation. Based on the analysis of cost of water, this paper explores which types of cost should be reflected in the water pricing enhancing the sustainability of water resources. The principle of full cost pricing in which the cost should include supply cost, opportunity cost and externalities is proposed as a means to achieve the sustainability of water resources. In a case study of Beijing, low water price is analyzed as one reason for unsustainable water consumption. Thus water pricing justified is necessary and pressing. It is proposed to justify water price in phased manner and eventually towards full cost pricing. The assessment of impacts on water resources by raising water price shows water pricing could alleviate the conflict between water supply and demand. This paper concludes that water pricing can play an effective role in enhancing the sustainability of water resources in Beijing.

China↗
PubMed2002

Logistical considerations for emergency response resources.

Resource management is a critical component of disaster preparedness and response. The type and quantity of resources and supplies needed by any particular community will be determined by several factors including the disasters affecting the community, existing resources within the community, resources available from neighboring communities, and the vulnerability assessment of a community. Ideally only needed resources should be requested and delivered. Unsolicited aid can often hamper an emergency response. The needs of a community will change during a disaster. Often the immediate need focuses on the medical sector. Issues such as hygiene, water and shelter will occur later. Disaster planning and logistical management of resources should not only consider the short-term needs of the community but also the long-term consequences of a disaster on the community.

Communication↗
PubMed2003

[The investigation of the licorice resources in northeast China].

OBJECTIVE: To find out the licorice(Glycyrrhiza uralensis) distribution area, resource complexion and resource reserves of northeast China, to analyze the cause of the swing of the pendulum of resources, to put forward the countermeasure of resource protection and to provide evidence for the establishment of relative statutes. METHOD: Combination of visit-inquisition and sample-square investigation involving the resource complexion of the 32 counties and cities in the northeast China wasmade. RESULT AND CONCLUSION: The east distribution boundary and the whole distribution current of licorice in the northeast China were determined the northeast licorice distributing region was compartmentalized into three typical sub-regions, and the licorice population character and artificial disturbing status in main counties of every sub-region were described. The licorice reserves were also figured out. At the same time, the nature and the artificial factors that influenced the swing of the pendulum of licorice resource were analyzed, and the correlative safeguard measure was brought forward.

China↗
PubMed2000

User perceptions on coastal resource state and management options in Curaçao.

Public environmental awareness and support for management measures are key determinants of the scope for successful implementation of natural resource management. To assess user perceptions and opinions on resource state and potential management options for the coastal zone of Curaçao, we queried 250 coastal resource users from around the island (sport divers, part-time artisanal fishermen and recreational boaters) using questionnaires. There is wide awareness of a long-term decline in coastal resource condition as measured by various indicators. Even among fishermen there was wide awareness of anthropogenic contributors to the decline, broad agreement of management measures required and a general willingness to contribute to management by means of annual license fees. Some of the more salient findings include the endorsement by fishermen of the current ban on spearfishing (81%), the regulation of the beach seine fishery for scad (77%), the introduction of fish reserves (72%), special protection for sea turtles (90%), conch (82%), and lobsters (72%), and notable support for gradual elimination of trap fisheries (45%). Also, both divers (65%) and boaters (92%) expressed the importance to them of an attractive coastline, with both groups expressing preference for natural (un-built) coastline (>74%) above other categories. Management based on the concept "user pays", as already implemented in the Netherlands Antilles on Saba and Bonaire, is well supported by the resource user public. A review of other main constraints such as finances and institutional capacity, shows that conditions are quite favorable for implementation of new legislation. Modem coral reef management is urgently needed in Curaçao to safeguard a key natural resource and concerted action is called for on the part of government agencies, legislators and elected officials.

Animals↗
PubMed2004

A survey of urological manpower, technology, and resources in Canada.

INTRODUCTION: Knowledge of the current status of manpower and resources is important in understanding the state of any medical specialty, and critical in planning for future recruitment, funding and infrastructure development. METHODS: In 2003, the Canadian Urological Association (CUA) conducted two nationwide surveys examining manpower, resources, and the technology available. One survey went only to academic and hospital leaders across the country (the resources survey), while the other was sent to the entire general membership of the CUA. RESULTS: The response rate for the resources survey was 67%, while that for the membership survey was 50.4%. The respondents' ages were evenly distributed, with the modal 5-year range being 51 to 55 years of age. Eighty-eight percent of respondents were Canadian-trained. Two-thirds of respondents spent over 80% of their practice time in direct patient care, and most practiced general urology. The majority of respondents practiced in smaller hospitals: 57.6% in centres with 300 or fewer inpatient beds, and 47.2% of centres reported < 500 procedures/year. Community hospitals (62% of responses to the resources survey) generally had fewer advanced technologies than academic centres. A quarter of the cystoscopy equipment used by respondents was over 15 years old. CONCLUSIONS: The results of these surveys present a snapshot of the current state of urology resources and manpower across Canada, potentially allowing better planning and negotiations with hospitals and governments.

Biomedical Technology↗
PubMed2005

Interdisciplinary conflict analysis and conflict mitigation in local resource management.

Within the Swedish research program SUCOZOMA (Sustainable Coastal Zone Management) several conflict studies have been carried out. Whereas the detailed results of these studies are published separately, this paper reviews important results from conflict research in combination with a summarizing and generalizing discussion of approaches and main results of SUCOZOMA's resource and conflicts studies. After an analysis of interdisciplinary and theoretical research about environmental and resource use conflicts, the methodology used in SUCOZOMA is presented, a combined stakeholder and conflict analysis. It can be summarized in four main points: i) to map the stakeholders and their interests; i) to analyse the conflicts; iii) to develop methods for conflict mitigation and cooperation with stakeholders; iv) to integrate these components in a system for the management of natural resources. Exemplary case studies of resource use conflicts have been carried out at the Swedish west and east coast including coastal fishery, mussel culture, coastal planning and specific conflicts such as between species protection (seals) and coastal fishery. Researchers are involved as experts and as conflicting parties, and the role of scientists as stakeholders deserves special attention in conflict research. Conflict management is not only for the solution of present conflicts, but part of integrated resource management systems where knowledge transfer, institutional development, collective learning of scientific, political and administrative actors, and cooperation between scientists and resource users can occur.

Animals↗
PubMed1986

Assessment and resource utilization for cancer patients.

To determine whether rehabilitation counselors and nurses differ in their approaches to using assessment information in care planning, 70 oncology outpatients returning to a comprehensive cancer center for continuing health care were asked to indicate their rehabilitation problems on a checklist. Follow-up consisted of clarifying problems and making relevant resources available to patients. Forty-five patients were followed by a clinic nurse (RN) whose expanded role included assessment and resource utilization functions; 25 were followed by a rehabilitation counselor (RC) whose only role was to perform assessment and resource utilization functions. The RC was found to address a significantly higher proportion of patient problems than the RNs (z = 6.94, p less than .0005). Both the RCs and RNs used many different resources to meet patient needs (43 vs 51). However, RNs used themselves as a resource for 51% of the problems addressed whereas the RC used the RN for 14% of problems addressed (z = -6.01, p less than .0005). Delegation of assessment and resource utilization functions to staff members as a sole responsibility may be an effective way to incorporate rehabilitation into an outpatient oncology setting.

Cancer Care Facilities↗
PubMed1995

Influence of clinical resources on the treatment of intermittent claudication.

Management of intermittent claudication varies between surgeons, even after adjustment for case-mix, and could be related to the availability of clinical resources. The aim of this study was to ascertain whether vascular surgeons perceived deficiencies in the resources available to them for the management of claudication and to determine whether an association existed between reported deficits and patient management. Over a six month period, 28 vascular surgeons in Scotland completed recording forms on their treatment intentions for 1,180 claudicants. Subsequently, the surgeons were interviewed about resources available for vascular surgery. The majority of surgeons reported deficiencies in resources, predominantly insufficient operating lists (71%) and staff shortages (71%). Although considered less important than clinical factors or patient wishes, resources were independently associated with treatment. Surgeons reporting insufficient operating lists were less likely to opt for surgical treatment (p < 0.05), and those working with reluctant or inexperienced radiologists were less likely to consider percutaneous transluminal angioplasty (p < 0.05) and more likely to offer surgery (p < 0.001). However, case-mix and resources explained only some of the variations in treatment. The residual variation was likely to reflect an underlying lack of agreement among surgeons on the most appropriate management of claudication. Randomised controlled trials to address this issue would be welcomed by the majority of surgeons questioned.

Angioplasty, Balloon↗
PubMed1993

To each according to need: a community-based approach to allocating health care resources.

OBJECTIVE: To develop a method of allocating publicly funded health care resources among communities according to their relative levels of need for health care independent of their current patterns of use. DESIGN: For each health care program population mean levels of resource allocation were calculated and were adjusted for age and sex to produce a national age- and sex-adjusted share of program resources. Indices of relative need for health care (for most programs the standardized mortality ratio) were derived from existing data on aspects of illness and death and were then used to weight the age- and sex-adjusted shares for between-community differences in health risks and health care needs. SETTING: The populations of the 49 counties in Ontario were used as the communities among which resources were allocated. Health care expenditures in 1988-89 by the Ontario Ministry of Health were used as the "budget." MAIN RESULTS: Age- and sex-adjusted resource allocations weighted for between-community differences in health care needs differed from allocations based on population size, in certain cases by up to 100%. CONCLUSION: Existing data can be used to propose allocations of health care resources that relate to relative levels of need for care across communities.

Canada↗
PubMed1996

Orthodontic treatment outcome in three Swedish counties with different orthodontic resources.

The orthodontic treatment outcomes of 350 19-year-old individuals in three Swedish counties (A, G, and W) with different orthodontic resources and geographic structures were analyzed. The aim was to evaluate the qualitative outcome of orthodontic treatment provided by general practitioners or specialists. In a small rural area (county G), with most specialist resources, the standard of the treatments was high in both specialist treated as well as in nonspecialist treated individuals. The possibilities for the specialists to supervise the nonspecialist care and to treat individuals in need of specialist treatment were good. In an urban area (county A), with less specialist resources (than county G), the standard of the treatments provided by the specialists was high, and higher than the untreated individuals in the same county. The standard of the treatments provided by general practitioners was, however, low. The lack of specialist resources had implied a greater restriction on starting treatments, and the treatments were performed in a higher age than in the other two counties. In a large rural area (county W), with the fewest specialist resources, the standard of the treatments was in general lower than in the other two counties and did not attain the standard of the untreated individuals in county W. Attempts to compensate for a sparsity of orthodontic specialists by an extended engagement of general practitioners resulted in a generous attitude of providing orthodontic treatments, and a lower standard of the treatments in general. The orthodontic treatments substantially improved the malocclusions, especially treatments provided by specialist. The standard of the treatments in the counties showed a good correlation with the available resources in terms of orthodontic specialists and the ability to supervise the treatments of general practitioners. The lack of sufficient supervision of non-specialist orthodontic treatment had negative influence on the quality.

Adult↗