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PubMed2002

An innovative surgical suture and needle evaluation and selection program.

This report describes an innovative suture and needle clinical evaluation program jointly designed by hospital representatives of Consorta, Inc., a healthcare resource management and group purchasing organization, and United States Surgical/Davis & Geck Sutures (USS/D&G), manufacturer of surgical biomaterials. Nineteen Consorta shareholder hospitals enrolled 699 surgeons to participate in Phase I of this nonexperimental observational study of the clinical performance of surgical needles and sutures. Performance characteristics of the sutures and needles produced by USS/D&G, which were evaluated in 3407 surgical procedures, included packaging and ease of opening, needle strength and sharpness, tissue drag, knot security, tensile strength, and clinically acceptable and unacceptable determinations. In these 30-day studies, the surgeons concluded that the needles and sutures were clinically acceptable in 98.1% of the evaluations. The general, cardiothoracic, and orthopedic surgeons, who performed 73.8% of the product evaluations, reported that the suture and needle products were clinically acceptable in 97.2% of the evaluations. More than half (50.1%) of the evaluations involved the POLYSORB* braided synthetic sutures,which received a clinically acceptable rating in 98.4% of the evaluation. The next most frequently used sutures were the SOFSILK*, followed by the monofilament nylon suture. SOFSILK* was found to be clinically acceptable in 98.7% of the evaluations, whereas the monofilament nylon was noted to be clinically acceptable in 96.3% of the evaluations. Surgical needles made by USS/D&G had a 97.9% clinical acceptability rating.

Attitude of Health Personnel↗

PubMedDate not supplied

Case study: improving efficiency in a large hospital laboratory.

Saint Francis Health System (SFHS) consists of three hospitals and one clinic: Saint Francis Hospital (SFH); Broken Arrow Medical Center; Laureate Psychiatric Hospital; and Warren Clinic. SFHS has 670 physicians on staff and serves medical (oncology, orthopedic, neurology, and renal), surgical, cardiac, women and infant, pediatric, transplant, and trauma patients in Tulsa County, Oklahoma, which has a population of 660,000. SFH incorporates 706 staffed beds, including 126 pediatric beds and 119 critical care beds. Each year, the health system averages 38,000 admissions, 70,000 emergency department visits, 25,000 surgeries, and 3,500 births. Saint Francis Laboratory is located within the main hospital facility (SFH) and functions as a core lab for the health system. The lab also coordinates lab services with Saint Francis Heart Hospital, a physician-system joint venture. The Optimal Equipment Configuration (OEC) Project was designed by the Clinical Laboratory Services division of Premier, a group purchasing organization, with the goal of determining whether laboratories could improve efficiency and decrease unit cost by using a single-source vendor. Participants included seven business partners (Abbott, Bayer, Beckman/Coulter, Dade/Behring, J&J/ Ortho, Olympus, and Roche) and 21 laboratory sites (a small, mid-sized, and large site for each vendor). SFH laboratory staff embraced Premier's concept and viewed the OEC project as an opportunity to "energize" laboratory operations. SFH partnered with Abbott, their primary equipment vendor, for the project. Using resources and tools made available through the project, the laboratory was re-engineered to simplify workflow, increase productivity, and decrease costs by adding automation and changing to centralized specimen processing. Abbott and SFH shared a common vision for the project and enhanced their partnership through increased communication and problem solving. Abbott's area representatives provided for third-party design expertise and quarterly metric reporting through Argent Consulting. Abbott incorporated lessons learned from the SFH OEC project with organizational changes to improve the way they work with customers. Following is a step-by-step description of the OEC project to allow others to benefit from the experience (Figure 1).

Efficiency, Organizational↗

PubMed2004

Helping tomorrow's retirees manage "distribution phase" risks.

Much of employers' attention has focused on helping employees manage the accumulation of 401(k) plan assets rather than on helping them manage the distribution phase--the period during which employees begin drawing down their 401(k) savings to meet their retirement needs. Assisting employees in managing the distribution phase can play an important role in helping employers meet a range of workforce planning goals and ensuring a maximum return on the retirement dollars that have been invested by both employees and the company. By implementing a properly structured approach to help employees manage the distribution phase, employers can help them maximize the value of their retirement savings at little or no employer cost, thanks to the leverage of the company's group purchasing power and the tax advantages of employer-sponsored plans.

Aged↗

PubMed1992

Two largest national alliances fine-tune strategies as health care environment changes. Interview by Howard J. Anderson.

The nation's two largest alliances of not-for-profit hospitals and systems are refining their roles for the 1990s. American Health Care Systems (AmHS) and Voluntary Hospitals of America (VHA) are moving away from strategies designed for competition in the marketplace of the 1980s, and toward helping their members change the way they deliver health care in their communities. While AmHS is promoting its health care reform proposal, VHA sees its existing 29 regional organizations of hospitals as a potential infrastructure for the development of community-based, integrated networks of care as envisioned in the AHA's reform plan. Experts add that the alliances clearly have to go beyond group purchasing to serve the changing needs of their members.

Community-Institutional Relations↗

PubMed1990

Electronic data interchange for pharmacy inventory control.

The use of electronic data interchange (EDI) for controlling pharmacy inventory at a 303-bed hospital is described. The hospital, which belongs to a group purchasing consortium, uses EDI to exchange information with its primary drug wholesaler. The pharmacy's personal computer and software provided by the wholesaler are used. EDI enables the pharmacy to (1) select and order items by using hand-held bar-code scanning devices, (2) upload this information into the pharmacy's computer, (3) review the order before transmission, and (4) access the wholesaler's inventory. The pharmacy also uses EDI with its primary i.v. supplier. Using EDI for placing the daily pharmaceutical and i.v.-supply orders reduces by one half the daily time expenditure for purchasing. In addition, EDI provides various inventory-related reports. EDI provides an efficient and effective way to control pharmacy inventory.

Computer Communication Networks↗

PubMed1990

ASHP national survey of hospital-based pharmaceutical services--1990.

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during May through July 1990 are reported and compared with the results of earlier ASHP surveys. A sample of community hospitals (short-term, nonfederal) was selected randomly from the population of community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 881. The net response rate was 66% (582 usable replies). The average number of hours of pharmacy operation per week reported by the respondents was 96. Complete unit dose drug distribution was offered by 89% of the respondents (up from 74% in 1987). About 70% offered complete, comprehensive i.v. admixture programs (essentially unchanged from 1987). Most of the hospitals (70%) had centralized pharmaceutical services. A computerized pharmacy system was present in 64% of the departments, and 75% had at least one microcomputer. More than 90% reported participation in adverse drug reaction and drug-use evaluation programs. Some 80% participated in drug therapy monitoring. Almost half of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records. Approximately one third provided patient education or counseling, and one third provided drug management of medical emergencies. A well-controlled formulary system was in place in 58% of the hospitals; therapeutic interchange was practiced by 49%. A total of 98% of the respondents participated in group purchasing, and 96% used a prime vendor. Half of the departments served as training sites for pharmacy students. Less than half had a staff development program, but about two thirds supported continuing-education activities for pharmacists. The 1990 survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys and identified static areas that merit the attention of pharmacy leaders.

Centralized Hospital Services↗

PubMed1988

ASHP national survey of hospital pharmaceutical services--1987.

The results of a fall 1987 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, 1982, and 1985. A sample of 875 hospitals was selected randomly from among the estimated 5600 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had a 71.1% response rate (617 usable replies). Nearly three-fourths of the respondents had complete unit dose drug distribution services (UDD), 68% reported complete i.v. admixture services (IVA), and 57% reported both complete UDD and complete IVA. Nearly 5% of respondents offered five specified clinical services (up from 1.8% in 1985); 24% reported having no clinical services (versus 38% in 1985). Nineteen percent said their departments had one or more clinical specialists. Overall, about one-third of pharmacy technicians had completed formal training. The number of respondents with programs to contain drug costs increased about 10% since 1985. Weekly hours of pharmacy operation averaged 102; 36.7% of respondents had pharmacy service around the clock. The percentage of hospitals with computerized drug distribution systems increased from 32% in 1985 to 52% in 1987. Prime vendors were used by 94.6% of respondents, and only 2% reported that they did not use a purchasing group. National expenditures for drugs and fluids for community hospitals were projected at $4.7 billion, personnel costs at $1.8 billion, and other pharmacy expenditures at $0.4 billion. The projected numbers of open positions nationally for pharmacists in community hospitals was 1950. The survey also collected data on the use of personal computers, inventory turnover, quality assurance, continuing-education philosophy, revenue-generating programs, and outpatient services. Drug control in community hospitals is improving, and clinical services are more widespread. Twenty percent of respondents had comprehensive pharmaceutical services, defined as complete UDD and complete IVA plus three or more clinical services.

Computers↗

PubMed1986

Legal implications of hospital resales of pharmaceuticals. American Hospital Association Office of General Counsel.

The legal implications of and restrictions on hospital resales of pharmaceuticals are analyzed to help hospital managers distinguish between legitimate drug redistribution and illegal drug diversion and, thus, enable them to conform to the law in their own resale practices. The requirements of the Robinson-Patman Act regarding resales are discussed, and the application of those requirements is explained. Particular attention is given to descriptions of dispensations that are permissible, those that are not permissible, and those that result from group purchasing arrangements. Other legal issues that must also be considered as possible problems are breach of contract suits; fraud, not only according to state law but also under the Racketeer Influenced and Corrupt Organizations Act; exposure to product liability; adverse tax consequences; and violations of the Federal Food, Drug and Cosmetic Act. Many resale practices are legitimate, but others may constitute illegal drug diversion. Hospital managers should review their institutions' procedures and correct those activities that may be inappropriate or questionable. At a time when concern is being focused on potential public-health risks created by illegal drug diversion, hospitals must play a constructive role in helping to solve the diversion problem.

Commerce↗

PubMed1980

Group buying a plus for clinical equipment.

Although so far few hospitals have ventured into group purchasing of clinical equipment, three multi-hospital systems have found it to be an effective tool for cost containment.

Capital Expenditures↗

PubMed1980

Electrocardiographic studies in African green monkeys (Cercopithecus aethiops).

Electrocardiograms obtained as part of a pre-experimental clinical examination were analyzed for a newly purchased group of 46 male African green vervets. In general, they were similar to electrocardiograms reported for other Old World species. An unexpectedly high prevalence (17%) of electrocardiogram abnormalities was found in this young (4--6 years of age) vervet population. The main abnormalities were nonspecific T wave flattening, left axis deviation, peaked P waves, RSR' patterns, and abnormally deep Q waves.

Animals↗

PubMed1994

Projecting future drug expenditures--1994.

The use of information on inflation, generic competition, market introduction of new drug entities, institution-specific drug-use patterns, and federal legislation to project drug expenditures is discussed. Inflation of pharmaceutical prices has been decreasing over the past few years. Increases in the producer price index for drugs and pharmaceuticals diminished from 6.9% in 1991 to 4.3% in the first half of 1993; the specter of government regulation may be one reason. Pharmacy group purchasing organizations (GPOs) predicted that in 1994 expenditures would increase an average of 2.1% for contracted drug items and 8.3% for noncontracted items. Expenditures for biotechnology drugs in January through July 1993 increased 16% over the same period in 1992; such agents are now hospital pharmacies' third most costly drug category, at 10% of total expenditures. Future price competition by generic drug products can be predicted from information on patent or market-exclusivity expiration. To predict the market release of new drug products, new-drug applications filed with FDA can be monitored. The most important component in projecting drug expenditures is a specific institution's pattern of use of high-cost drugs. Mechanisms that can be used to monitor changes in therapeutic strategies and drug-use protocols include drug cost indexes, assessment of drug-use patterns by outside companies, and computerized models for specific high-cost drugs. Drug expenditures can be affected by legislative changes such as the Medicaid rebate provisions of the Omnibus Budget Reconciliation Act of 1990 and the Medicare outpatient drug benefit in the proposed American Health Security Act. The accuracy of projections of drug expenditures can be improved by examining inflation, generic competition, the introduction of new drug entities, institution-specific drug-use patterns, and legislative issues. Pharmacy managers need better methods for estimating institution-specific use of high-cost drugs.

Drug Approval↗

PubMed1993

ASHP national survey of hospital-based pharmaceutical services--1992.

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during summer 1992 are reported and compared with the results of earlier ASHP surveys. A simple random sample of community hospitals (short-term, nonfederal) was selected from community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 889. The net response rate was 58% (518 usable replies). The average number of hours of pharmacy operation per week was 105. Complete unit dose drug distribution was offered by 90% of the respondents, and 67% offered complete, comprehensive i.v. admixture programs. A total of 73% of the hospitals had centralized pharmaceutical services. Some 83% provided services to ambulatory-care patients, including clinic patients, emergency room patients, patients being discharged, employees, home care patients, and the general public. A computerized pharmacy system was present in 75% of the departments, and 86% had at least one microcomputer. More than 90% participated in adverse drug reaction, drug-use evaluation, drug therapy monitoring, and medication error management programs. Two thirds of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records, and the same proportion provided patient education or counseling. One third provided drug management of medical emergencies. One fifth provided drug therapy management planning, and 17% provided written histories. Pharmacokinetic consultations were provided by 57% and nutritional support consultations by 37%; three fourths of pharmacist recommendations were adopted by prescribers. A well-controlled formulary system was in place in 51% of the hospitals; therapeutic interchange was practiced by 69%. A total of 99% participated in group purchasing, and 95% used a prime vendor. The 1992 ASHP survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys (e.g., growth in clinical services, ambulatory-care services, computerization) and identified static areas that merit the attention of pharmacy leaders (e.g., provision of complete, comprehensive i.v. services).

Adverse Drug Reaction Reporting Systems↗

PubMed1997

Initial success and substantial government savings may mandate prime vendor contracts for Table of Organization and Equipment units and development support.

In November 1994, the Department of Pharmacy at Madigan Army Medical Center and the 62nd Medical Group Logistics (Fort Lewis, Washington) examined the feasibility of prime vendor support for the 18th Mobile Army Surgical Hospital in a Table of Organization and Equipment (TOE) unit rapid deployment. The TOE medication list was deemed to be out of date and a state-of-the-art formulary was developed. By identifying three National Drug Code bioequivalent substitutes for each National Stock Number, a 94% prime vendor match was achieved for pharmaceuticals form the new formulary serving as our template. The 6% of medications that were not able to be matched consisted of items deemed as military-unique or items not covered by the prime vendor government contracts with wholesalers. On August 7, 1995, a trial was conducted to determine whether the local prime vendor had the capacity to support a deployment under its present contract with Madigan Army Medical Center. Two hundred eighty-six line items were ordered, mocking the deployment of two medical units. More than 95% of the line items were filled within 5 days from the local prime vendor. Under the local contract, the prime vendor was under no obligation to have out-of-stock medications provided by overnight shipment from other national distribution sites. This advantage, which is standard in national pharmaceutical prime vendor contracts negotiated by large civilian group purchasing organizations, would have substantially decreased the period of time to attain a > 95% fill. The results of this trial have provided strong support for prime vendor utilization in future deployments.

Contract Services↗

PubMedDate not supplied

Managed dental care in the HMO setting.

DHMOs are gaining in popularity, and are the fastest-growing dental managed-care product, primarily because of their ability to reduce premium and patient costs. Dentistry, because of the strong correlation between prevention and disease control, is more suited to a managed-care system than medicine. However, there remains a wide gulf between theory and practice, as the DHMO industry continues to evolve. Poorly designed programs will save money but create problems with patient satisfaction and unmet treatment needs. Well-designed programs use the principles of population management to bring large numbers of patients to maintenance oral health levels. In any event, the continuing growth and development of DHMOs will benefit patients, group purchasers, and the dentists who can understand and embrace the concepts of dentistry in the HMO environment.

Capitation Fee↗

PubMed1998

Public and private health initiatives in Kansas.

This article summarizes several health initiatives in Kansas that are being forwarded by way of public/private partnerships. Consensus is being shaped on the standardization of health data and use of actionable indicators. Statewide public health improvement planning is also being pursued. A group of large employers and state agencies are creating a basis for group purchasing, consumer assessments of health plans, and coordinated public policy formulation.

Health Planning Organizations↗

PubMed1999

The information requirements of total purchasing projects. Implications for primary care groups.

To successfully purchase, commission and manage health services at the primary care level requires accurate, reliable, up-to-date and appropriate information for use by trusts, health authorities, and by the soon to be operational primary care groups. The national total purchasing evaluation has provided evidence which will be relevant to primary care groups, particularly in the areas of information technology (IT) and access to information. Progress in developing independent purchasing by total purchasers was slower than anticipated because of the large number of factors which had to be taken into account, of which IT and information were just two. Accurate and timely information will be crucial for primary care groups if they are to move from level 1 to level 4 without undue delay.

Budgets↗

PubMedDate not supplied

Suzanne F. Delbanco on the Leapfrog Group and employer purchasing power. Interview by Pamela K. Scarrow.

Suzanne F. Delbanco, PhD MPH, is the first executive director of The Leapfrog Group, founded by the Business Roundtable. The Leapfrog Group's goal is to mobilize employer purchasing power to initiate breakthrough improvements in the safety, quality, and overall value of healthcare for American consumers. The group's growing consortium of more than 155 Fortune 500 companies and other large private and public healthcare purchasers provides health benefits to more than 34 million Americans; these companies spend more than 62 billion dollars on healthcare annually. Dr. Delbanco is a member of the National Committee for Quality Assurance Purchaser Advisory Council and a board member of Bridges to Excellence. Before joining The Leapfrog Group, she was a senior manager at the Pacific Business Group on Health (PBGH), where she worked on the quality team. Prior to joining PBGH, she worked on reproductive health policy and the changing healthcare marketplace initiative at the Henry J. Kaiser Family Foundation. She has also consulted on health insurance coverage in the temporary employment industry and on the first statewide survey in California of MediCal beneficiaries, and worked as a community Liaison for Kaiser Permanente during the establishment of one of California's first County Organized Health Systems. She holds a PhD in public policy from the Goldman School of Public PoLicy and a MPH from the School of Public Health at the University of California, Berkeley.

Health Benefit Plans, Employee↗

PubMed1996

Income, health status, and insurance coverage of small group employees in a voluntary purchasing arrangement.

The ongoing health care reform discussion has highlighted the problems of insuring small group employees. Several state and private initiatives have attempted to address some of these problems through the formation of voluntary small group purchasing arrangements. This article uses data from one such initiative, Health Care Group of Arizona (HCGA), to describe the income, health status, and prior insurance of small group employees who enrolled in prepaid health plans through HCGA. It also compares employee enrollees to nonenrollees along these dimensions. The findings suggest that HCGA enrollees had relatively low incomes and that about three-quarters were without health insurance prior to enrollment. Higher income employee enrollees were more likely to report health conditions at enrollment even after controlling for other factors including age. Enrollees were less likely than nonenrollees to have prior health insurance but were more likely to be drawn from lower income groups and to report recent health conditions.

Adolescent↗