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PubMed1982

Self-administration of intravenous antibiotics: an efficient, cost-effective home care program.

The effects of a home care program with 102 courses (2336 patient-days) of intravenous antibiotic therapy were evaluated. Home care nurses changed the intravenous cannula site every 3 days. The initial hospital stay averaged 11.8 days and the duration of home therapy averaged 22.9 days. The diseases treated included osteomyelitis, septic arthritis, endocarditis, cystic fibrosis and pneumonia, staphylococcal bacteremia, blastomycosis, actinomycosis and other soft tissue infections. All classes of commonly used antibiotics, including penicillins, cephalosporins, aminoglycosides and amphotericin B, were administered, alone or in combination. There were no side effects that necessitated discontinuation of home treatment or readmission to hospital. The average cost per patient-day was $58, compared with an estimated $193 for in-hospital therapy; in addition, 2336 hospital bed-days were made available. Most patients were able to resume many or all of their daily activities while receiving intravenous antibiotic therapy.

Adolescent↗
PubMedDate not supplied

Planning an agency-wide inservice.

From planning an inservice program on a relatively simple change to presenting a number of changes together, the challenge for nursing staff development specialists is to provide high-quality programs in an efficient and effective manner to achieve identified outcomes. In this article, the author reviews considerations in the formative stages of a hospital-wide inservice program, with a focus on planning to achieve quality, efficiency and effectiveness, and measurable outcomes.

Efficiency, Organizational↗
PubMedDate not supplied

The benefits of using hospitalists.

A good hospitalist program will more than pay for itself by improving outcomes, reducing length of stay, and enhancing hospital efficiency. Moreover, the program can often attract primary care physicians who prefer to use the service of a hospitalist.

Cost Control↗
PubMed2001

Applying cost analysis methods to school-based prevention programs.

In order to efficiently allocate scarce prevention resources, policymakers need information about the economic costs of school-based substance use prevention programs. The objective of this paper is to outline economic cost analysis methods and demonstrate their applicability to school-based prevention programs. As an example, the paper focuses on estimating the economic cost of ALPHA, an intensive school-based substance use prevention program. The cost of ALPHA is compared to the costs of 3 elementary school programs that were alternatives to ALPHA. We collected cost information for 3 years, using a cost questionnaire that was completed by program and school budget officers and school principals. The program costs obtained from these sources were modified to conform to well-established economic cost analysis principles.

Child↗
PubMedDate not supplied

Improving productivity in child welfare programs.

The project met its objective of finding ways to improve the efficiency of a child welfare program. The agency will continue an intensive evaluation of the program to reassess the procedures' impact on productivity. The project found that, with adaptation, work-methods techniques developed in industry can be useful to child welfare programs. Critical elements in the success of a productivity improvement project include full, visible support by the agency's policy makers and top management; early intensive involvement of affected personnel; wide implementation of recommended improvements; and continued review of their effectiveness. Although no single work-methods project can solve all problems connected with an agency's way of carrying out its work, the process developed by the Texas Department of Human Resources can be applied usefully by both public and private child welfare agencies as they seek ways to improve the efficiency of their programs.

Child↗
PubMed1987

Measuring hospital performance. A non-parametric approach.

In this paper a technique for assessing the relative performance of firms is introduced and applied to a sample of hospitals in California. Hospitals are compared on the basis of their relative technical efficiency. The reference technology is constructed from observed outputs and inputs (including physicians) using programming techniques, and efficiency is assessed relative to the frontier of the technology using measures similar to those suggested by Farrell. The technique used here imposes no prespecified functional form, allows for multiple outputs and inputs (allowing for differences in case mix), and yields information on the productive performance of individual hospitals. This technique can also be used to determine whether different types of hospitals use different technologies. Our results, although illustrative rather than definitive, suggest that ownership affects 'efficiency' as measured here: public and NFP hospitals have 'different' best practice frontiers, and public hospitals appear to use relatively fewer resources. These results could reflect differences in quality of care by ownership.

California↗
PubMed2007

The impact of food supplementation on infant weight gain in rural Bangladesh; an assessment of the Bangladesh Integrated Nutritional Program (BINP).

OBJECTIVES: To examine the efficiency of the Bangladesh Integrated Nutritional Program (BINP) in identifying which infants should be supplemented, whether full supplementation was given for the stipulated period of time, and whether the correct exit criteria from the supplementation programme were used. To test whether targeted food supplementation of infants between 6-12 months of age resulted in enhanced weight gain. SETTING: Mallickbari Union, Bhaluka, a rural area located about 100 km north of Dhaka, Bangladesh. PARTICIPANTS: Five hundred and twenty-six infants followed for 6 to 12 months. RESULTS: Of the 526 infants studied, 368 should have received supplementation based on BINP criteria but only 111 infants (30%) did so, while a further 13% were incorrectly given supplementation. So in total over half (52.8%) of the sample was incorrectly identified for supplementation. In addition, less than a quarter of the infants received the full 90 days of supplementation and close to half of the infants exited the programme without the requisite weight gain. Infants were assigned to one of four groups: correctly supplemented, correctly non-supplemented, incorrectly supplemented or incorrectly non-supplemented. This classification provided natural controls; the correctly supplemented infants versus the incorrectly non-supplemented infants, and the correctly non-supplemented infants versus the incorrectly supplemented infants. There were no significant differences in weight gain between the correctly supplemented group and the incorrectly non-supplemented group or between the correctly non-supplemented and the incorrectly supplemented groups, nor was there any evidence of growth faltering in the incorrectly non-supplemented group. CONCLUSIONS: This study found serious programmatic deficiencies - inability to identify growth faltering in infants, failure to supplement for the full time period and incorrect exit procedures. There was no evidence that food supplementation had any impact on improving infant weight gain.

Bangladesh↗
PubMed1993

Behavioral management of chronic pain and excess disability: long-term follow-up of an outpatient program.

OBJECTIVE: To assess the overall efficiency of an outpatient behavioral rehabilitation program for excess disability and chronic pain and to describe the program staff, treatment components and outcomes in sufficient detail to facilitate comparison with similar programs. DESIGN: Eight-year follow-up study of patients referred and treated. SETTING: Outpatient primary care and multispecialty group medical practice. PATIENTS: 354 of 421 unselected patients referred for the behavioral management of excess disability, who completed the treatment program and participated in follow-up. INTERVENTIONS: 15-20 sessions of physical and occupational therapy, 5-10 sessions of biofeedback, and one or two family sessions all based upon behavioral techniques described by Fordyce and by Roberts. MAIN OUTCOME MEASURES: Questionnaires, including analog scales, administered before treatment and at 1, 6, 12, and 24 months posttreatment. RESULTS: Patients (n = 67) who dropped out did not differ systematically from those who participated (n = 354). The treatment program resulted in a marked and enduring reduction of pain, and a statistically and clinically significant improvement in patients' ability to function at work and in the home. Patients overwhelmingly endorsed the program. CONCLUSIONS: A brief, inexpensive, outpatient behavioral rehabilitation program for chronic pain and excess disability can achieve a clinically significant and lasting reduction of pain and improvement in function at work and at home.

Adolescent↗
PubMed2002

[Is it necessary to rehabilitate coronary artery disease patients based on ventilatory threshold?].

PURPOSE: To compare the efficiency of two programs of exercise-based rehabilitation that are different for heart rate (HR) training in patients with coronary artery disease: heart rate (HR) according to Karvonen formula (HR training =70% (max HR -rest HR) +rest HR) or HR recorded at the gas exchange ventilatory threshold (VT). TYPE: Controlled randomised clinical trial. SETTING: Cardiovascular rehabilitation unit. METHOD: Twenty-four male patients (54 +/-9.5 years old) with coronary artery disease were allocated at random to one of the two groups: KHR group (n =13) according to Karvonen formula (n =11), and VTHR group according to VT determined by exertion test (n =13). The exercised-based program was similar for all the patients, differing only in HR training (five daily sessions a week for four weeks). Assessment tests were performed at D1 and D28 and included: - an exercise test with measure of HR and double product (HR x blood pressure) at rest, submaximal and maximal intensity, with measure of oxygen consumption and gas exchanges at rest and at maximum exercise; - specific functional tests based on daily life activities; - dyspnea assessment at maximal intensity; - quality of life measurement by SF36. It was taken notice of the drugs taken by the patients, specially betablockers. RESULTS: At inclusion, the two groups were not different for parametric (age, body mass index) and non parametric values (medical or surgical treatment, comorbidity). Even though HR training was significantly different (p <10(-6)), at the end of the program there was a significant increase of power and oxygen consumption at VT (+42.6%, p <10(-6); +18.6%, p <10(-5)) and at maximal intensity (+18.7 %, p <10(-6); 14.2 %, p <10(-5)), but differences between the two groups were not significant; double product was significantly lower at rest (-13.9 %, p <10(-5)) and at submaximal exertion (-10.6 %, p < 10(-3)). Yet, the two groups differed in HR, and HR increased in VTHR group and decreased in KHR, the difference being significant at VT (p =0.05), at submaximal (p =0.037) and maximal exercise (p = 0.05). Dyspnea at maximal intensity was higher in VTHR but SF36 values were not different. DISCUSSION AND CONCLUSION: These results confirm the efficiency of cardiac training program according to Karvonen formula as to ventilatory threshold. However, there is a negative chronotropic effect of cardiac training according to Karvonen formula with a higher intensity, which corresponds to a less cardiac work for a same activity.

Anaerobic Threshold↗
PubMed1998

[Malignant transformation in ulcerative colitis and surgical implications].

Patients with ulcerative colitis (UC) are at higher risk for cancer. Risk factors are duration of disease, extent of colitis, associated primary sclerosing cholangitis and possibly early onset of UC in childhood. Epithelial dysplasias are considered as precursors of colorectal cancer within the concept of an inflammation-dysplasia-carcinoma sequence. Dysplasia originates multifocally and is difficult to identify by colonoscopy. Histomorphological diagnosis can also be problematical. Surveillance programs utilize colonoscopy with random biopsies to diagnose dysplasia in patients with risk factors. The efficiency of these programs can be markedly increased when certain rules are applied. The ultimate aim must be to perform a proctocolectomy in patients at higher risk before invasive cancer develops. With only a few exceptions, colorectal cancer in UC can be treated by restorative proctocolectomy. Partial resection of the colon should be avoided because of the high frequency of occult carcinomas and multifocal carcinogenesis. There are first results that indicate a higher risk for malignant deterioration in the terminal ileum. After an ileoanal pouch procedure patients with chronic pouchitis seem to have a higher risk for dysplasia. At the moment the risk for malignancy cannot be calculated because of the relatively short follow-up time after ileoanal pouch procedures. However, it is recommended that after restorative proctocolectomy patients be followed by endoscopy and random biopsies for the rest of their lives.

Cell Transformation, Neoplastic↗
PubMed2000

Review of programs for persons who are homeless and mentally ill.

Despite recent prosperity in the U.S., homelessness is still a widespread social problem. It is estimated that 25% of homeless persons have a serious mental illness. This article will review the literature evaluating prevention services and specialized outreach, treatment, and housing programs designed to reduce homelessness for individuals who are mentally ill. Although these interventions have been helpful in addressing the complex needs of the homeless mentally ill, it is difficult to measure how they have improved outcomes. It is even more challenging to determine whether the programs are cost-effective. Since public resources are used to maintain services for the homeless mentally ill, policy-makers must be informed about whether the best outcomes are achieved at the lowest possible cost. Following a discussion of the successes of the individual programs and the challenges they confront, several important questions are identified related to improving the efficiency of these programs. Although the establishment of such programs indicates that progress has been made toward alleviating the burdens facing people who are homeless and mentally ill, collaboration among all stakeholders-especially between the mental health community and consumer advocates-needs to be further enhanced. New research can be conducted in a way that improves how information is evaluated and used.

Adult↗
PubMed2000

VA telephone care program gives pharmacists authority to solve zero-refill problem.

Running out of refills on a chronic medication is a pain for patient and a burden on the healthcare system. The VA Palo Alto (CA) Health System says its telephone care pharmacy program is a cost-efficient approach to the problem. Program pharmacists can extend prescriptions for chronic medications to last until patients have their next doctor's appointment. Here's how it works.

California↗
PubMed1995

SAFE (strategy, assessment, flexibility, and efficiency) for future use? Stages in master planning, programming, and architectural design.

Health care facility design must incorporate four key elements: Strategy, Assessment, Flexibility, and Efficiency. These SAFE elements will offer the organization the greatest return on investment, because they encompass both present needs and future demand. They respect the integrated nature of functional operations by clustering them in ways that permit growth or consolidation. In the rapidly changing health care environment, flexibility is fundamental to successful design.

Ambulatory Care Facilities↗