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Results for “Concurrent Review”

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At least 469 records · Page 26Linked to original sources
PubMed2001

[Cause of non-pertinent hospital stays: interobserver concordance using the French version of the Appropriateness Evaluation Protocol].

BACKGROUND: The modified French version of the Appropriateness Evaluation Protocol (AEPf) has been validated. Inappropriate days according to simple medical and technical criteria are identified with this tool. The aim of this study is to highlight the interest of investigating the reasons for inappropriate days and to assess the inter-observers reliability of the questionnaire developed for this purpose. METHODS: This questionnaire collects on one hand the needs of patients - distinguishing health care and accommodation needs - and on the other hand the reasons for inappropriate hospital days. The data were collected from January to September 1998 in nine voluntary medical and surgical departments. For each day of study randomly selected, each inappropriate hospital day according to AEPf has been included. Data were collected by two health professionals (a nurse and a physician), using a concurrent design. RESULTS: The reliability of the over-ride option of the appropriateness assessment of the 345 hospital days was good (overall Kappa coefficient: 0.66; 95% CI: 0.55-0.78). The comparison of the two expert judgments on health care needs fulfilled during the hospital day was acceptable; the Kappa coefficient was 0.62 (95% CI: 0.52-0.72). The reliability of expert assessment on patient accommodation needs (home, housing facilities or hospital) was good (Kappa coefficient: 0.67; 95% CI: 0.60-0.75). When hospital was not the accommodation the most adapted for patient, the reliability of the reasons for inappropriate days was high (Kappa coefficient: 0.75; 95% CI: 0.61-0.80). Kappa coefficients were different between hospitals, indicating a center effect. CONCLUSION: This instrument has been found to be reliable and should be used in complement of the first part of the AEPf which assess the prevalence of inappropriate days. It might help to detect dysfunctions within or outside the hospital and thus be used for evaluation or planning of health care.

Adult↗
PubMed2001

Next phase of medical management systems: automating administrative transactions to integrate payors and providers.

Today, medical management is burdened by the cost and hassle of manual administrative tasks. Manual intensive processing (that is, phone and fax) of referral requests and institutional authorization transactions results in significant unnecessary costs for the providers and payors, delays in approval, and problems with errors. To address these administrative burdens, the next phase of online (Internet- and wireless-enabled) medical management applications will focus on the administrative and transaction side, including self-service referral and authorization processing between the payor and provider. The advent of the Health Insurance Portability and Accountability Act (HIPAA) greatly improves the ability to gain widespread adoption of these online applications thanks to mandated standardization of many routine transactions. This article explores this next phase of online administrative and transaction medical management applications from the payors' perspective and explores their connectivity with providers. Payors are striving to meet several objectives as they implement these online administrative and transaction medical management systems: reducing the administrative burden and cost, changing traditional medical policies, increasing provider adoption of connective technologies, addressing HIPAA compliance, and achieving higher levels of system integration.

Computer Communication Networks↗
PubMed2002

ED diversions reduced by tight monitoring.

Hospital had no good system for measuring flow through the organization. Mechanism to ensure action is a key element in program's success. Giving nurses greater control drops staff vacancy rates and boosts satisfaction.

Benchmarking↗
PubMed2002

[Combined gemcitabine and radiotherapy].

Gemcitabine is a molecule presenting with major radiosensitizing or radio-potentiator capacities. This property has been extensively studied in vitro, with clinical therapeutic implications. Chemotherapy and radiation are very often used together, most of the time concurrently. This review analyses the results obtained with combined gemcitabine and radiation, for non small cell lung cancer, pancreatic adenocarcinoma, head and neck and uterine cervix carcinomas. Several therapeutic schemes are presented, for each tumor location. A description of the toxicities observed is presented, including the recall phenomenon description. Promising results justify the numerous current trials, as well as enthusiasm initiated by this therapeutic association.

Adenocarcinoma↗
PubMed2002

Profiling resource use: do different outcomes affect assessments of provider efficiency?

OBJECTIVES: To examine whether 2 outcome measures result in different assessments of efficiency across 22 service networks within the Department of Veterans Affairs (VA). STUDY DESIGN: A retrospective analysis using VA inpatient and outpatient administrative databases. METHODS: A 60% random sample of veterans who used healthcare services during fiscal year 1997 was split into a 40% sample (n = 1,046,803) for development and a 20% sample (n = 524,461) for validation. Weighted concurrent case-mix models using adjusted clinical groups were developed to explain variation in 2 outcomes: "days of care"--the sum of a patient's inpatient and outpatient annual visit days, and "average accounting costs"--the sum of the average service costs multiplied by the units of service for each patient. Two profiling indicators were calculated for each outcome: an unadjusted efficiency index and an adjusted efficiency index. These indices were compared to examine network efficiency. RESULTS: Although about half the networks were identified as "efficient" before and after case-mix adjustment, assessments of individual network efficiency were affected by the adjustment. The 2 outcomes differed on which networks were efficient. For example, 4 networks that appeared as efficient based on days of care appeared as inefficient based on average costs. CONCLUSIONS: Assessments of provider efficiency across the 22 networks depended on the outcome measure used. Knowledge about the extent to which assessments of provider efficiency depend on the outcome measure used is an important step toward improved and more equitable comparisons across providers.

Adult↗
PubMed1992

Clarifying concurrent care.

Pennsylvania Blue Shield's concurrent care policy for both the Medicare program and its private business is the source of much confusion and exasperation among physicians, especially with regard to medical-medical concurrent care. This article seeks to clarify the process for better understanding by physicians.

Blue Cross Blue Shield Insurance Plans↗