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PubMedDate not supplied

The Medical Education Commission Report 2002: trends indicate a steady state supply of physicians.

This summary report for 2002 provides the detailed and updated data on all Graduate Medical Education (GME) residents and fellows in Louisiana for the last academic year. The 2002 match results and the trend in matching over the last 4 years depict the consistent successful match by Louisiana institutions. The totals and components of GME in Louisiana are steady. The infusion of gradually increasing numbers of physicians over the last 30 years in the United States and in Louisiana is quantified to indicate the present consistent steady state production and supply. The ripple effect into the physician population of this infusion now shows the expected beginning stabilization, although incomplete at this juncture. While demand for physician services for healthcare delivery is difficult to define and quantify, the inexorable increase of utilization of healthcare services portends a future mismatch of supply and demand, a shortage not a surplus.

Education, Medical↗
PubMedDate not supplied

Clinical pathway after hip fracture.

PURPOSE: Hip fracture occurs frequently, resulting in considerable morbidity, mortality and utilization of healthcare resources. Technical advances in fracture fixation and surgical treatment have improved outcomes following hip fracture in the elderly. However, further improvement in outcomes of hip fracture patients may be possible with utilization of a clinical pathway designed to enhance outcomes in a standardized, cost-effective manner. This paper presents a clinical pathway for the treatment of hip fractures in the elderly with the above aims. METHOD: The clinical pathway presented is based on personal experience and literature pertaining to the treatment of the elderly hip fracture patient. It outlines a suggested algorithmic approach to the patient that begins with the initial evaluation, progresses on through pre-operative and operative management, and ends with post-operative rehabilitation and treatment. RESULTS: The clinical pathway for the hip fracture patient in this paper is a working treatment algorithm that has been successful in personal experience. CONCLUSION: This treatment algorithm has been utilized successfully in personal experience. Further input from healthcare professionals may prove to enhance outcomes in a cost-effective, standardized manner.

Aged↗
PubMed2005

Impact of a migraine management program on improving health outcomes.

The goals of this program were to evaluate the effectiveness of migraine disease management techniques in improving patient satisfaction with migraine care, decreasing the frequency and severity of headaches and migraine-associated disability, increasing the effectiveness of migraine treatment and work productivity, improving physician diagnosis and treatment of migraine, and ultimately determining the program's impact on healthcare resource utilization. A prospective observational study was undertaken. This prospective Migraine Management Program (MMP) used active patient and healthcare physician-based disease management resources, tools, and techniques. Members were identified using administrative and medical claims databases indicating an ICD-9 diagnosis code (346.XX) for migraine during the previous twelve months. All identified patients received the Migraine Therapy Assessment Questionnaire (MTAQ) to assess their level of migraine control for pre/post measurement. Of the 2,134 patients responding to the initial MTAQ, 789 completed both a baseline and follow-up and 1,345 completed only a baseline questionnaire. For those patients completing both, there was a statistically significant reduction in all identified management issues: poor symptom control, high attack frequency, knowledge/behavior barriers, economic burden, and dissatisfaction with treatment. Comparing the former group to those completing only the baseline MTAQ, the latter were significantly more likely to report problems with three migraine management issues; poorer symptom control, greater economic burden, and dissatisfaction with their treatment. The use of appropriate patient and physician educational interventions, such as Aetna's MMP incorporating disease management principles and the MTAQ questionnaire, can have a significant impact on patient-centered outcomes and satisfaction with their migraine treatment.

Adult↗
PubMedDate not supplied

Transferring management technology: healthcare quality improvement education in central and eastern Europe.

The newly independent nations of the former Soviet Union continue to restructure and refine their political and economic environments. Competition for scarce of dwindling economic resources within these nations and between the nations of an expanding global community necessitates that they adopt more efficient and effective management methods to provide essential public services. As a result, organizational management concepts developed and used in the West (i.e., in the United States and the countries of the European Union) are eagerly sought for incorporation into new administrative systems. This is an opportune time for healthcare service management educators to develop and present total quality management (TQM) programs, stressing continuous quality improvement (CQI) methods specifically targeted and adapted to the organizational needs of these countries, as they restructure their societies from centrally planned to market-driven economies. In general, educators in healthcare service management, acting as information consultants, can play a pivotal role in guiding strategies for healthcare organizational change and in helping to stabilize transitional organizational processes, by providing guidelines that can improve utilization of healthcare resources and monitoring of healthcare service outcomes. Most of the observations and recommendations presented in this article are derived from the author's experiences in conducting healthcare management improvement projects in Bulgaria in 1993 and in Lithuania since 1991.

Commonwealth of Independent States↗
PubMed1999

Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis.

OBJECTIVE: To evaluate the cost utility of interferon beta-1b in secondary progressive multiple sclerosis. DESIGN: Population based cost utility model (healthcare perspective). Data on use of health services were obtained from case records and routine morbidity data and utility values from a EuroQol survey. Local and published costs were used. Effectiveness was modelled using data on relative risk reductions from a randomised trial of interferon beta-1b. SETTING: Tayside region, 1993-5. SUBJECTS: 132 ambulatory people with secondary progressive multiple sclerosis. MAIN OUTCOME MEASURES: Cost per quality adjusted life year (QALY) gained. Rate of relapse and proportion becoming wheelchair dependent over three years. RESULTS: The number needed to treat for 30 months to delay time to wheelchair dependence in one person by nine months was 18 (95% confidence interval 5 to 26). For every 18 people treated for 30 months, six relapses would be prevented, gaining 0.397 discounted QALYs. The cost per QALY gained was 1 024 667 pounds sterling (276 466 pounds sterling to 485 499 pound sterling). If treatment was restricted to patients attending neurology services, the number needed to treat was 14 (cost per QALY gained 833 pounds sterling 514 (161 358 pounds sterling to infinity)). The cost per QALY gained was not sensitive to changes in cost which took account of a societal perspective. CONCLUSIONS: The cost per QALY gained from interferon beta is high because of the high drug cost and modest clinical effect. Resources could be used more efficiently elsewhere.

Activities of Daily Living↗
PubMed2003

The burden of COPD in Canada: results from the Confronting COPD survey.

Chronic obstructive pulmonary disease (COPD) is a condition characterized by progressive airflow limitation, with symptoms of dyspnoea, cough, and sputum production. Aside from information on prevalence, mortality and hospital resource utilization arising from COPD in Canada, there is a lack of data on the impact of the disease on primary care healthcare resource utilization and the economic burden of the disease (i.e. direct and indirect costs). Canada is not unusual in this respect, as surprisingly few studies have attempted to quantify the impact of COPD on the healthcare system and society in other countries. In an attempt to address the need for information on the burden of COPD, an economic analysis of data from a large-scale international survey, Confronting COPD in North America and Europe, was conducted in Canada and six other countries. The results of the Canadian survey estimated the direct cost of the disease at CA dollar 1997.81 per patient, with over half of this due to inpatient hospitalizations. COPD also had an impact on the economy, with indirect costs amounting to CA dollar 1198.18, a third of the total per patient cost of COPD to society (CA dollar 3195.97). Reducing the impact of this disease will necessitate improvements to the way the disease is managed in primary care, as poor symptom control and frequent exacerbations are key drivers of hospital and other unscheduled care costs. Early diagnosis and the application of available but underused interventions (e.g. smoking cessation, inhaled drug therapies and pulmonary rehabilitation) could reduce the morbidity and costs of COPD in this country.

Absenteeism↗
PubMed2004

Value-based medicine and ophthalmology: an appraisal of cost-utility analyses.

PURPOSE: To ascertain the extent to which ophthalmologic interventions have been evaluated in value-based medicine format. METHODS: Retrospective literature review. Papers in the healthcare literature utilizing cost-utility analysis were reviewed by researchers at the Center for Value-Based Medicine, Flourtown, Pennsylvania. A literature review of papers addressing the cost-utility analysis of ophthalmologic procedures in the United States over a 12-year period from 1992 to 2003 was undertaken using the National Library of Medicine and EMBASE databases. The cost-utility of ophthalmologic interventions in inflation-adjusted (real) year 2003 US dollars expended per quality-adjusted life-year (dollars/QALY) was ascertained in all instances. RESULTS: A total of 19 papers were found, including a total of 25 interventions. The median cost-utility of ophthalmologic interventions was 5,219 dollars/QALY, with a range from 746 dollars/QALY to 6.5 million dollars/QALY. CONCLUSIONS: The majority of ophthalmologic interventions are especially cost-effective by conventional standards. This is because of the substantial value that ophthalmologic interventions confer to patients with eye diseases for the resources expended.

Cost-Benefit Analysis↗
PubMed2006

[High utilization of health insurance services by the elderly--analysis of hospital and drug utilization data].

The present contribution discusses the utilization of the healthcare system by elderly patients in Germany. First, the paper focuses on the detailed characterization of a group of people aged 60 years or more (N = 73,454). Second, the objective is to analyze the data for high utilization of healthcare services by older men and women. The analysis is based on data regularly recorded by a German health insurance agency for the year 2000. High utilization is operationalized by a 10% cutoff for users with the highest number of treatments, highest costs and/or other criteria depending on the respective health service sector. The insured group investigated received approximately 1.4 million prescriptions, producing costs of 42 million E. High utilizers account for 32% of all prescriptions and 44% of the costs, respectively. At the same time, the age groups with the highest prescription rates do not cause the highest costs: So the relationship between age and prescription drug expenses as well as between age and prescription rates does not display an arithmetically increasing pattern. Within the timeframe investigated 26,000 hospital treatments were accounted for by 21.75% of the elderly under research. In total, they caused expenses of 88 million E. High utilization in the hospital sector was operationalized by four criteria. Sex- and age-specific analysis of high utilization of hospital treatment revealed that the four different criteria apply to different insured groups. In summary, the high utilization of healthcare services appears to be a multidimensional phenomenon.

Aged↗
PubMed2006

Use of healthcare, patient satisfaction and burden of care in Guillain-Barre syndrome.

OBJECTIVE: The aim of this study was to investigate, in an unselected sample of patients with Guillain-Barré syndrome in Sweden, the utilization of healthcare resources, satisfaction with these resources, informal help and the burden of care on family caregivers during the first 2 years after onset. SUBJECTS: Forty-four patients were enrolled from 8 hospitals, and 42 of them were followed for 2 years. METHODS: Data on the utilization of hospital inpatient and outpatient care, primary care and community-based services were collected via computerized registry information, medical records and a specific protocol. Patient satisfaction and the burden on family caregivers were studied using questionnaires. RESULTS: Forty-one patients required inpatient hospitalization for a mean of 82 days. Patients with persistent dependency during activities of daily living had significantly longer hospital stays and more days of outpatient rehabilitation. The majority of patients were satisfied with their care, but dissatisfaction was found regarding information and finances. At 2 years after onset, 26% of patients still depended on informal help. The spouses expressed increased concern and responsibility for household and family. CONCLUSION: Patients with persistent disability due to Guillain-Barré syndrome were found to have long-term need for services from the healthcare system and informal help.

Activities of Daily Living↗
PubMed2003

Economic analysis of the Confronting COPD survey: methodology.

Chronic obstructive pulmonary disease (COPD) is a condition characterized by progressive airflow limitation, which causes considerable morbidity and mortality worldwide. Yet the burden of COPD is poorly recognized, and the disease remains an inadequately managed health problem. Few studies have attempted to quantify the impact of the disease on patient health, the healthcare system and society as a whole. This provided the rationale for Confronting COPD in North America and Europe, the first large-scale international survey of the burden of COPD. This paper describes how quantitative measures of healthcare resource utilization and workplace productivity loss were derived from patient responses to the Confronting COPD survey, to investigate the country-specific impact of COPD on the healthcare system and society. The aim of this analysis is to inform countries of the economic impact of the condition, and demonstrate the need for better COPD treatment to improve health and reduce the sizeable burden of this disease.

Absenteeism↗
PubMedDate not supplied

Am empirical study of selected cost measures of clinical engineering service effectiveness.

The growing demand for more and better healthcare service greatly expands the role of medical equipment in providing health services more effectively. The purpose of introducing clinical engineering programs in hospitals was to improve the effectiveness of healthcare institutions' utilization and management of medical technology. Over the last decade, the role of clinical engineering has grown in importance as a component of hospitals and the healthcare delivery system. Hospital administrators currently put a strong emphasis on cost effectiveness of clinical engineering services, to reduce the cost of acquisition and maintenance of equipment. Unfortunately, the lack of a commonly accepted definition of cost effectiveness has resulted in a certain amount of confusion over how the performance of clinical engineering services can or should be measured. The results presented in this paper should assist hospital administrators and clinical engineering program managers to establish a common understanding of what "cost effectiveness" means and how it can be achieved.

Biomedical Engineering↗
PubMed2002

Clinical outcomes and resource utilization associated with haemophilia care in Europe.

We conducted a multicentre, cross- sectional study of 1042 haemophilia subjects across Europe to compare various health outcomes associated with on-demand vs. prophylactic factor-substitution therapy. Demographic, medical history, and healthcare resource utilization data were analysed along with the number of bleeding events over the past 6 months. Treatment-cost data were also examined to provide preliminary information for future economic studies. A logistic regression analysis, controlling for other statistically significant covariates, showed that patients treated on demand were 3.4 times more likely to have had a joint bleed over the previous 6 months than those treated with prophylaxis. Multiple regression analyses further confirmed these findings, because on-demand subjects had, on average, 5.15 more joint bleeds over the reporting period than patients treated with prophylaxis. Notably, these findings were even more dramatic for younger haemophilia patients when our study sample was stratified by age. Due to the high cost of factor replacement, healthcare costs were significantly higher for subjects treated prophylactically. While hospital costs for prophylaxis subjects were, on average, lower, statistically significant cost savings for prophylactic subjects were not noted. These results suggest that clinicians and health policy decision-makers should consider the advantages of prophylactic therapy for haemophilia patients in formulating treatment protocols and allocating health resources.

Age Factors↗
PubMed2003

Assessment and management of patients with venous, arterial, and diabetic/neuropathic lower extremity wounds.

Most healthcare providers recognize that management of lower extremity wounds presents a difficult challenge. These chronic wounds significantly impact the quality of life for individuals and have implications for costs and utilization of healthcare resources. Lower extremity wounds can be due to a myriad of different diseases, but the primary causes are chronic venous insufficiency, lower extremity arterial disease, and diabetes/neuropathy. Differential assessment is necessary prior to implementation of management strategies in order to address the etiology and pathogenesis factors that are related to each type of leg wound. This article presents an overview of the risk and predisposing factors for venous, arterial, and diabetic/neuropathic wounds. Additionally, it addresses issues of differential assessment including typical locations, common clinical characteristics, typical wound appearance, key management issues, considerations for alternative treatments, collaborative care, and patient/family education.

Diabetic Neuropathies↗
PubMed2007

Psychological treatment may reduce the need for healthcare in patients with Crohn's disease.

BACKGROUND: Few published studies examine the influence of psychological treatment on health care utilization in Crohn's disease. METHODS: The present substudy of a prospective, randomized, multicenter trial conducted in 69 of 488 consecutive Crohn's disease (CD) patients was designed to investigate the way in which healthcare utilization is influenced by psychotherapy and relaxation in addition to standardized glucocorticoid therapy. Before and after a 1-year period of standardized somatic treatment the psychotherapy and control groups were compared with regard to hospital and sick-leave days. Predictors of healthcare utilization were analyzed. RESULTS: The comparison between groups before and after psychological treatment showed a significantly higher decrease of mean hospital days (P < 0.03) and sick-leave days in the treatment group compared with the controls. When a covariate analysis was applied to compare the data at randomization, the difference in hospital days remained statistically a trend (P < 0.1). Multivariate regression analysis detected a significant gender and depression effect for hospital days (cor r(2) = 0.114) and a significant gender and age effect for sick-leave days (cor r(2) = 0.112). CONCLUSION: A significant drop in healthcare utilization after psychological treatment demonstrates a clear benefit of this additional therapy. This is important, since the study failed to demonstrate significant changes in the psychosocial status or somatic course of study patients. Clinical and psychological factors influencing these outcomes are discussed.

Adolescent↗
PubMed1999

Possibilities and limitations in the functional use of medical practice profiles.

The first use of medical practice profiles in the Belgian healthcare organization goes back to 1980 with the creation of practice pattern evaluation at the National Institute of Health and Invalidity Insurance (RIZIV). Since then, detailed information on the provision and on the utilization of healthcare has become increasingly important in the planning, budgeting and financing of the nation healthcare. The RIZIV uses practice profiling predominantly as a means to control aberrant prescription (e.g. clinical chemistry, medical imaging, pharmaceuticals) and provision of care (diagnostic tests). In 1991, the Federal Ministry of Health started using data on diagnosis and medical performance for hospital admissions in order to adapt the per diem price and the yearly quotum of admission days attributed to each hospital. At the level of the health insurer (sickness funds) there is growing interest to share the information derived from the extremely detailed patient claims for reimbursement of intramural and ambulatory care. These billing data allow the evaluation of medical care provision per physician, per hospital or provision center and per patient for a given period of time. The lack of specific diagnosis indication restricts mainly the use of these data as medical performance parameter to surgical procedures. The purpose of this profile information for the health insurer is to point to the physician the important medical practice variability in identical clinical situations in order to stimulate the design and implementation of practice guidelines and reduce aberrant differences in practice patterns. The use of medical practice profiles, in close collaboration of insurers and providers is considered extremely valuable as a means to improve the quality of healthcare provision.

Ambulatory Care↗
PubMed2004

An issue of culture: the effects of daily activities on prenatal care utilization patterns in rural South Africa.

Utilization of healthcare facilities has been extensively analyzed in developed countries by researchers from a wide range of disciplines. However, there is still a need to develop a better understanding of the temporal and spatial factors that affect rural women within developing countries. An important piece of this exploration is addressing time constraints and the cultural context. After time has been spent attending to essential tasks that the entire family is dependent upon, do rural women have "disposable time" left to visit a healthcare facility? The setting for this study is the Ubombo Magisterial District, a northern rural area of KwaZulu Natal, South Africa. Environmental factors and socio-economical factors that motivate or discourage women from utilizing prenatal care are addressed using a multinomial logit model. Many of the factors documented in literature as affecting prenatal care utilization, i.e. age and parity, do not apply in this area. On the other hand, fetching water as a daily activity, which is usually not associated with prenatal care utilization, has a significant effect on utilization.

Adolescent↗
PubMed2007

Trial participation and vaccine desirability for Vi polysaccharide typhoid fever vaccine in Hue City, Viet Nam.

OBJECTIVES: To identify demand for Vi typhoid fever vaccine for school-age children; obstacles and enabling factors for vaccine delivery; and socio-behavioural factors associated with trial participation and possible predictors of future vaccine acceptance, in Hue City, Viet Nam. METHODS: Pre- and post-trial surveys of randomly selected households with children aged 6-17 years. Simple multinomial logistic analyses for ratios of relative risks (RRR) and significance on trial participation by demographics and variables related to typhoid fever, vaccination, and pre-trial experiences with information and consents. Multiple logistic regressions to assess differences in participation based on child's characteristics. RESULTS: As many as 62.6% of households let all school age children participate, 10.2% let some participate, and 26.8% let none of their children participate in the trial. Factors associated with all children participating included past use of healthcare facilities (RRR, 0.45; 95% CI, 0.24-0.83), knowledge of vaccines (RRR, 0.17; 95% CI, 0.03-0.86), and perceived causes of typhoid fever (RRR, 0.90; 95% CI, 0.81-0.99). Factors associated with some children participating included utilization of healthcare facilities (RRR, 0.08; 95% CI, 0.01-0.66) and perceived severity of typhoid fever (RRR, 0.64; 95% CI 0.46-0.88). Participation was associated with satisfaction regarding pre-vaccination information and consent procedures. Children and adolescents were active decision-makers. Only 14 of 461 (2.2%) respondents would not use the Vi vaccine in the future for their child(ren). CONCLUSIONS: Inter-related factors contribute to participation in a clinical vaccine trial, which may differ from desire to participate in a public health campaign. Educational campaigns need to be targeted to children and adolescents, and consideration for assent procedures for minors. Obtaining informed consent may affect trial participation within a social and political system unaccustomed to these procedures.

Adolescent↗