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PubMed1992

More resources better health? A cross-national perspective.

This study is an attempt to examine the relative importance of health care resources in predicting infant mortality within industrialized, developing, and underdeveloped countries. The analyses were based on the data of 117 countries. Findings from this study suggest that health resources as a whole do not make a significant contribution to accounting for the variance of infant mortality rates over and above the variance accounted for by socioeconomic resources only. The contribution of health resources to the health of the population as a whole is really rather small in comparison to the role of socioeconomic resources.

Developing Countries↗
PubMed1996

Gene co-ops and the biotrade: translating genetic resource rights into sustainable development.

The 1992 Convention on Biological Diversity marks a basic change in the international status of genetic resources. Prior to the Convention, these resources were considered to be the "heritage of mankind.' Although the intent of this open access regime was to ensure the widespread availability of genetic resources for agriculture and industry, commercial use of the resources provided no additional economic incentive for conservation by source countries. The Biodiversity Convention corrects this policy failure by establishing that states have sovereign rights over their genetic resources, thereby enabling market incentives to complement various multilateral mechanisms that might directly fund biodiversity conservation. A number of obstacles face countries that are translating this broad right to regulate access into specific policies, laws, and regulations designed to meet conservation and development objectives. A review of these obstacles and of trends in technological development suggest that nations and developing country institutions should take a set of actions to develop access legislation and Material Transfer Agreements, establish biodiversity "cooperatives' and intermediary institutions to facilitate information exchange, develop minimum standards for access legislation, and require that prior informed consent of local communities be obtained by all biodiversity collectors.

Animal Population Groups↗
PubMed2006

Randomized trial of medical treatment versus hysterectomy for abnormal uterine bleeding: resource use in the Medicine or Surgery (Ms) trial.

OBJECTIVE: This study was undertaken to compare resource use outcomes for participants in the Medicine or Surgery (Ms) randomized trial. STUDY DESIGN: In a randomized controlled trial, we compared resources used during a 24-month follow-up period by women with abnormal uterine bleeding who were randomly assigned to either expanded medical treatment or hysterectomy. RESULTS: Women randomly assigned to hysterectomy used significantly more resources (medicine = $4479, hysterectomy = $6777; P = .03), with almost all the difference caused by the hysterectomy procedure. Fifty-three percent of women randomly assigned to medicine had a hysterectomy during the follow-up period; women who were able to continue on medical therapy had mean total resource use of $2595 compared with $6128 for medicine patients who eventually had surgery. CONCLUSION: For women with abnormal uterine bleeding refractory to cyclic medroxyprogesterone acetate, compared with expanded medical treatment, hysterectomy increases resource use significantly and results in better clinical and 6-month quality-of-life outcomes.

Adult↗
PubMed2005

Educational and therapeutic resource dependency at early school-age in children who were born very preterm.

AIM: To examine the incidence of educational and therapeutic resource dependency in a group of very preterm children at 8 years of age. METHODS: All children with a gestational age less than 30 weeks, who survived to discharge from the neonatal intensive care unit at Royal Prince Alfred Hospital, between 1987 and 1994, were prospectively enrolled in developmental follow-up. At 8 years of age, information regarding resource dependency was obtained from parents and teachers using interviews and questionnaires. Standardized psychometric measures of cognition and academic achievement were administered. RESULTS: Information was obtained for 365 (73.3%) of surviving 8-year-old children; 65 (17.8%) had a neurosensory disability and 24 (36.9%) children in this group were in full-time special education. In those without neurosensory disability (n=300), seven (2.3%) children were already in full-time special education for an intellectual deficit. Among children in mainstream education, 154/293 (52.5%) had received or were still receiving additional assistance in some form (part-time special education, grade retention, therapeutic intervention or private tutoring). Difficulty in literacy was the most commonly reported problem. Resource dependency was not related to gestation nor predicted by intelligence in children without neurosensory disability, but was related to maternal education. Children who had had or were continuing to receive part-time assistance showed delays in academic skills at assessment. CONCLUSIONS: A high level of on-going resource dependency exists in this group in an attempt to maintain grade appropriate achievement. Resource dependency is not related to gestation in neurologically normal children. General cognitive measures of intelligence do not predict these problems in the majority of children.

Australia↗
PubMed2006

An integrated approach to modeling resource utilization for rural communities in developing countries.

Resource consumption in developing countries has been the focus of a considerable amount of research. What has been understudied however, has been the feedback affects of resource consumption on resource availability to both households and communities. Heavy reliance on natural resources and intensive smallholder agriculture common to many rural communities in developing countries has forced people to fulfill short-term needs to the detriment of long-term ecological and livelihood sustainability. This paper introduces a conceptual framework to examine how individuals and households fulfill daily caloric needs and the aggregate effects on resource availability and consumption. Data were collected from a large number of published case studies of rural land-use dynamics, growth and yield models, and human livelihoods were reviewed from scientific journals, reports published by NGOs, and government reports. Using inputs defined by the user, the model tracks annual fuelwood and agricultural land use based on meeting individual energy demands. A case-study-based analysis was patterned after smallholder agriculturalists at the family and community level. Three scenarios are presented in this paper using data from Uganda to illustrate the application of this model.

Adult↗
PubMed1997

Resource utilization control processes as indicators of quality in managed care organizations: a proposal.

Central to the development of a competitive market for managed care products is the ability to measure the quality of care provided by individual managed care organizations (MCOs). Several types of quality measures could be considered for this purpose: patient and provider satisfaction, a listing of specific services provided to patients, or clinical outcomes of such services. Although assessing quality with measures of the process of care is commonplace, we propose developing measures of the production processes that control utilization of health care resources within an organization. Evaluation of these production or resource utilization control processes, although not a substitute for health outcomes assessment, may improve our knowledge of the delivery of services within managed care organizations. We present a paradigm for evaluation of health care resource utilization control processes within managed care organizations based on our description of internal and external controls for health care resource management. This paradigm can serve as a framework for further research into the quality of care provided by these organizations and the processes of health care resource management in MCOs.

Health Resources↗
PubMed2003

Gastrointestinal health care resource utilization with chronic use of COX-2-specific inhibitors versus traditional NSAIDs.

BACKGROUND & AIMS: Cyclooxygenase 2 (COX-2)-specific inhibitors (coxibs) decrease gastrointestinal (GI) events in controlled trials, but results in clinical practice are unknown. We assessed GI-related resource use and costs in patients switching from chronic nonsteroidal anti-inflammatory drug (NSAID) therapy to chronic coxib therapy and in patients starting chronic NSAID therapy vs. chronic coxib therapy in a U.S. administrative claims database of >8 million lives. METHODS: "Switchers" (n = 2246) were assessed in the 12-month periods before and after switching from chronic NSAID therapy to coxib therapy. "New NSAID" (n = 25,989) and "new coxib" (n = 2125) groups were assessed for the 12-month periods before and after the initial prescription. Proportions of patients with GI resource use (odds ratio [OR] adjusted for relevant covariates) and costs were compared. RESULTS: The adjusted OR for any GI resource use (coxib vs. NSAID period) among switchers was 0.86 (0.74-0.99). The decrease was due to less GI cotherapy (OR = 0.82 [0.69-0.97]). Costs were not significantly lower after switching to coxibs (mean difference, -$19; 95% CI: -$139, $55), although after adding NSAID/coxib costs, the total cost in the coxib period was significantly higher (mean increase, $377; $271, $488). Adjusted OR for GI resource use for new-coxib vs. new-NSAID was 1.04 (0.92-1.16), but GI costs were significantly lower in new-NSAID patients. CONCLUSIONS: Patients switching from chronic NSAID therapy to chronic coxib therapy had a slight decrease in the proportion using GI-related resources but not in GI costs. When NSAID/coxib drug costs were included, costs were significantly less with NSAIDs than with coxibs. The potential GI-related cost savings suggested in coxib clinical trials may not be fully realized in "real-world" settings.

Adult↗
PubMed2002

Use of medical resources, complications and long-term outcome in patients hospitalized with acute chest pain. A comparison between a city university hospital and a county hospital.

OBJECTIVE: The primary aim was to test the hypothesis that there is a difference in long-term outcome after hospital discharge among patients hospitalized with acute chest pain in a university hospital and a county hospital. Secondary aims were to compare these two hospitals with regard to use of medical resources, occurrence of complications and risk indicators for death. PATIENTS: All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km(2)) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km(2)) due to symptoms of acute chest pain during a period of 6 months. RESULTS: Complications, use of medical resources and mortality during the subsequent 2 years after discharge were compared among 1,592 hospitalizations in a city hospital and 822 in a county hospital due to acute chest pain. Angina pectoris after the first event, congestive heart failure and various arrhythmias were more frequently reported in the county hospital. The use of medical resources differed. Thus, the use of betablockers, heparin, antiarrhythmics, diuretics and nipride was more frequent in the county hospital, whereas the use of nitrates, digitalis, coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was more frequent in the city hospital. Despite these differences, the mortality 2 years after hospital discharge was similar (14.7% in the city hospital and 12.8% in the county hospital, P=0.26). Two factors, intravenous digitalis in hospital and a prescription of insulin at discharge, were significantly more associated with death in the county hospital compared with the city hospital. CONCLUSIONS: When comparing a city university hospital with a county hospital with regard to patients admitted with chest pain, major differences in terms of complications and use of medical resources were found. Thus, various complications were reported more frequently in the county hospital. The use of medical resources varied, some being used more frequently in the county hospital, whereas others were used more frequently in the university hospital. Despite these differences the mortality 2 years after hospital discharge was similar in the two cohorts.

Acute Disease↗
PubMed2003

Behavioral externalities in natural resource production possibility frontiers: integrating biology and economics to model human-wildlife interactions.

Production possibility modeling has been applied to a variety of wildlife management issues. Although it has seen only limited employment in modeling human-wildlife output decisions, it can be expected that the theory's use in this area will increase as human interactions with and impacts on wildlife become more frequent. At present, most models applying production possibility theory to wildlife production can be characterized in that wildlife output quantities are determined by physically quantifiable functions representing rivalrous resources. When the theory is applied to human-wildlife interactions, it may not be sufficient to model the production tradeoffs using only physical constraints. As wildlife are known to respond to human presence, it could be expected that human activity may appear in wildlife production functions as an externality. Behavioral externalities are revealed by an output's response to the presence of another output and can result in a loss of concavity of the production possibilities frontier. Ignoring the potential of a behavioral externality can result in an unexpected and inefficient output allocation that may compromise a wildlife population's well-being. Behavioral externalities can be included in PPF models in a number of ways, including the use of data or cumulative effects modeling. While identifying that behavioral externalities exist and incorporating them into a model is important, correctly interpreting their implications will be critical to improve the efficiency of natural resource management. Behavioral externalities may cause a loss of concavity anywhere along a PPF that may compel managerial decisions that are inconsistent with multiple use doctrines. Convex PPFs may result when wildlife species are extremely sensitive to any level of human activity. It may be possible to improve the PPF's concavity by reducing the strength of the behavioral effect. Any change in the PPF that increases the convexity of the production set could offer natural resource managers additional opportunities to optimally provide multiple natural resource outputs. Techniques that minimize the effect could focus on either the human or wildlife outputs, or both. Methods could focus on reducing the externality itself through changing the production of the offending output or to reduce the impact of the externality through a change in the production of the affected output. Managers unfamiliar with PPF modeling can employ PPF thinking by recognizing that every decision involves tradeoffs and that sometimes these tradeoffs are unnecessary negative impacts that could be mitigated without compromising the resource.

Animals↗
PubMed1999

Reduced resource utilization in patients treated for postoperative nausea and vomiting with dolasetron mesylate. MCPR44 Study Group.

STUDY OBJECTIVE: To compare the effect of four different increasing increasing intravenous (i.v.) doses of dolasetron mesylate (12.5 mg, 25 mg, 50 mg, and 100 mg) versus placebo on resource utilization in patients who experienced and were treated for postoperative nausea and vomiting (PONV). DESIGN: Prospective, double-blind, randomized, multicenter study. PATIENTS: 620 ASA physical status I, II, and III male and female outpatients scheduled for surgery with general anesthesia. INTERVENTIONS: Patients who experienced postoperative nausea (duration > or = 5 min, self-reported as moderate to severe) or vomiting (> or = 1 emetic episode) within 2 hours of arrival in the postanesthesia care unit (PACU) were given a single i.v. dose of dolasetron mesylate (12.5 mg, 25 mg, 50 mg, or 100 mg) or placebo infused for at least 30 seconds. MEASUREMENTS AND MAIN RESULTS: Resource utilization in the PACU was assessed by time spent by nurses and/or doctors with patients for PONV and the use of hospital resources such as patient/bed linens and staff/emesis supplies. A significantly (p < 0.05) lower proportion of dolasetron-treated patients compared to placebo-treated patients required new patient/bed linens and staff/emesis supplies. Patients in the placebo group required the greatest amount of care from nurses and/or doctors compared to patients receiving dolasetron. CONCLUSIONS: Treatment with dolasetron can significantly decrease the utilization of emesis supplies and other hospital resources, including staff/emesis supplies and patient/bed linens. In addition, patients receiving dolasetron used fewer health care resources in time spent by hospital personnel than patients who were not treated with dolasetron.

Adult↗
PubMed2002

Resource implications of a knee referral.

INTRODUCTION: The latest government targets state that by the end of 2005 the maximum waiting time for an outpatient appointment will be 3 months. These recommendations will not only increase the size of the outpatient clinics, but also the resources required thereafter. The purpose of this study was to analyse the outcome of new patient referrals to one knee outpatient service in order to quantify the resources required to investigate and treat these patients. METHOD: All new patients attending one consultant's knee outpatient service in the time period January 1st 1997 to December 31st 1997 were prospectively entered into a database recording patient details, source of referral and diagnosis. Eighteen months after the time period a cohort of 200 patients was randomly selected and the case notes were analysed. The number of outpatient appointment episodes, MRI scans, physiotherapy referrals and surgical episodes generated were recorded for each patient. RESULTS: Analysis of the initial database records show that a total of 662 new knee referrals were seen in 1997. Fifty-two percent (341) were made up of the five most common diagnoses, these being osteoarthritis, anterior knee pain, anterior cruciate ligament injury, medial ligament injury and medial meniscus injury. Retrospective analysis of the 200 patient notes revealed that these patients required a total of 499 outpatient episodes, 43 MRI scans, 180 courses of physiotherapy and 93 surgical episodes (53 elective and 40 emergency). These figures can be used to predict the resources that would be required by all new patients seen in an outpatient knee service in a year. DISCUSSION: Each new patient that enters the cycle of investigation followed by treatment must be met by extra resources. If this does not occur the net result will be that although government targets may be met, the time taken to complete each patient episode will become longer. It is imperative that before an agreement is made to see new patients the resources required to manage them are in place.

Ambulatory Care↗
PubMed1997

Resource use and costs of elective surgery for asymptomatic abdominal aortic aneurysm.

OBJECTIVES: To determine the hospital costs of elective abdominal aortic aneurysm repair. DESIGN: Observational study of resource use. MATERIALS: Forty-six elective aneurysm surgery patients in a hospital; 116 vascular surgeons participating in the U.K. Small Aneurysm Trial. METHODS: Data on resource use and associated costs were obtained in 1993 for 46 patients who had undergone elective surgery in a teaching hospital. Comparability of resource use with other hospitals in the U.K. was obtained from data on surgical patients in the U.K. Small Aneurysm Trial, and by questionnaire on use of resources sent to surgeons participating in the trial. RESULTS: The total cost of an elective aneurysm repair calculated from patient data in the teaching hospital was Pounds 4592. One-third of costs were due to stay in a standard surgical ward, and 20% were attributable to the operation. Overall, the use of resources in U.K. hospitals was comparable to that for the teaching hospital. Based on the surgeons' estimates, however, considerable variation existed for typical elective aneurysm patients, with costs ranging from Pounds 2173 to Pounds 7024. CONCLUSIONS: In the U.K. the average cost of an elective aneurysm repair in 1993 was around Pounds 4600, which was equivalent to around Pounds 5000 (US$8000) in 1996. This estimate is sufficiently reliable to be used in cost effectiveness analyses.

Aged↗
PubMedDate not supplied

Water resource accounting for a mining area in India.

A water resource accounting study has been carried out for a limestone mining area located in Thondamuthur block of Coimbatore district under Tamilnadu state in India. The major source of surface water in the region is south-west and north-west monsoons during July-August and October-November, respectively. During the winter season, groundwater levels range from 13 to 25 m below the surface whereas during the summer season it varies from 20 to 30 m. The thickness of the weathered zone ranges from 10 to 40 m and the depth to bedrock ranges from 50 to 55 m. The groundwater is generally potable. The average annual rainfall during the twelve-year period (1988-1999) is 590 mm. Out of the total rainfall, around 11% is lost as surface runoff, 10% is lost through evaporation and transpiration, 30% is utilized for consumptive used, 16% is absorbed as subsoil loss and remaining only 33% is stored as groundwater recharge. Again out of total groundwater recharge only 85% is utilizable groundwater. The annual utilizable groundwater resource available in the area is 79.220 million cubic metre (MCM). Whereas, total groundwater demand for the region is 68.922 MCM, and breakup of industrial, domestic and agricultural demands are 0.020, 5.956 and 62.946 MCM, respectively. Therefore, at present the stage of groundwater development or utilization for the area is around 87%, and falls under 'Dark' category. The 'Dark' category indicates that the utilization of groundwater is more than 85% of available groundwater resource. This situation has to be controlled by immediate initiation of suitable measures for groundwater recharge. The identified recharge zones in the block along with the recommended recharging methodology are summarized in this paper. The paper includes a comprehensive site description, status of the water resource and demand, identification of recharge zones and recharging techniques, and recommends a water supply augmentation strategy for enhancement of water resources in the region.

Calcium Carbonate↗
PubMed2003

Resource use in the ICU: short- vs. long-term patients.

BACKGROUND: Intensive care medicine uses a disproportionate share of medical resources, and little is known about the distribution of resources between different patient groups. METHODS: In this prospective observational study, all patients admitted between 1 January 1998 and 31 December 1999 to our medical-surgical university's ICU were assigned to one of two groups according to length of stay (LOS): patients staying more than 7 days in the unit (group L) and those staying a maximum of 7 days (group S). Resource use was estimated using TISS-28, number of nursing shifts, use of mechanical ventilation, and use of renal replacement therapy. Further, SAPS II and ICU and hospital mortalities were recorded. RESULTS: Of 5481 patients, 583 (10.6%) were in group L and 4898 in group S (89.4%). Patients in group L were more severely sick upon admission than those in group S. Patients in group L stayed a total of 9726 days in the ICU (52.5% of the total LOS). In group L, 69.2% of all shifts with respiratory support and 80.1% of all shifts with renal replacement were used. Further, group L patients consumed 53.4% (909225) of all TISS points provided. The ICU-mortality rates were 14.4% in group L and 7.2% in group S, and the hospital mortality rates were 19.9% and 9.8%, respectively. A mean of 1898 TISS points was used per patient surviving the hospital stay in group L compared with 190 points in group S. CONCLUSIONS: In this university-based, medical-surgical adult ICU, 11% of all patients stayed more than 7 days in the unit and consumed more than 50% of all resources. Thus, a highly disproportionate amount of resources were used per survivor in group L compared with those in group S.

Adolescent↗
PubMed2002

The effect of participation in a weight loss programme on short-term health resource utilization.

Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervised weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass index (BMI) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P < 0.001). Mean annual number of emergency visits (pre = 0.2; post = 0.2) and hospital admissions (pre = 0.05; post = 0.08) did not change. Neither baseline BMI, nor its change during the programme, influenced changes in health resource utilization. Our study suggests that weight loss in a supervised weight management programme does not necessarily decrease short-term health resource utilization. Further study is required to determine if patients who maintain their weight loss experience a decrease in health utilization.

Adult↗
PubMed2005

Uncomplicated acute renal failure and hospital resource utilization: a retrospective multicenter analysis.

BACKGROUND: Although acute renal failure (ARF) complicating nonrenal organ dysfunction in the intensive care unit is associated with significant mortality and hospital costs, hospital resource utilization attributed to uncomplicated ARF is not well known. The goal of this study is to characterize the costs and lengths of stay (LOSs) incurred by hospitalized patients with uncomplicated ARF and their important determining factors. METHODS: We obtained hospital case-mix data sets from 23 Massachusetts hospitals for a 2-year period (1999 to 2000) from the Massachusetts Division of Health Care Finance and Policy. A total of 2,252 records of patients hospitalized with uncomplicated ARF were identified. Patient records of other common medical diagnoses were studied for comparison. RESULTS: Patients hospitalized with uncomplicated ARF incurred median direct hospital costs of 2,600 dollars, median hospital LOS of 5 days, and mortality of 8%. Dialysis was independently associated with significantly greater hospital costs and LOSs for patients with uncomplicated ARF (P < 0.05). Male sex and nonwhite race were associated with significantly lower hospital costs and LOSs, whereas type of hospital had opposing effects on these 2 resource utilization outcomes (P < 0.05). Unadjusted aggregate resource utilization associated with uncomplicated ARF exceeded that of many other common illnesses. CONCLUSION: Demographic and hospital factors, as well as dialysis therapy, are significant determinants of hospital resource utilization for patients with uncomplicated ARF. Uncomplicated ARF appears to incur greater hospital costs and longer LOSs compared with other common medical conditions. Greater focus should be directed toward further understanding of the factors influencing resource utilization for ARF.

Acute Kidney Injury↗
PubMed2003

On the possibility of a positive-sum game in the distribution of health care resources.

Health care resource distribution is a subject of debate among health policy analysts, economists, and philosophers. In the United States, there is a widening gap between the more- and less-advantaged socioeconomic sub-populations in terms of both health care resource distribution and outcomes. Conventional wisdom suggests that there is a tradeoff, a zero-sum game, between efficiency and fairness in the distribution of health care resources. Promoting fairness in the distribution of health care resources and outcomes is not efficient in terms of maximization of a health outcome production function. On the other side of the coin, improving efficiency comes at the expense of fairness. Such conventional wisdom is supported in part by standard static Paretian welfare analysis. However, in this paper it is shown that in a dynamic setting in which there are efficiency gains in the health production function, fairness in distribution of health care resources can improve simultaneously.

Efficiency, Organizational↗
PubMed1998

HIV-associated dementia: clinical, epidemiological and resource utilization issues.

Among mental disorders associated with HIV infection, dementia is the one most likely to have a major impact on public health, both as a result of the high levels of individual disability, and the greater demand of health care resource utilization. Epidemiologic and economic impact of HIV-associated dementia needs to be estimated, in order to provide policy makers and health managers with the information required for decision making and resource allocation. An increase in HIV encephalopathy prevalence rates may be expected as a consequence of longer survival time in dementia patients and in patients with other AIDS defining disease (longer survival increases the risk of developing HIV encephalopathy). A resource utilization study shows that, in the chronic stage of the disease, in-patient days per person-year are almost double in AIDS subjects with neurological complications as compared with those without neurological complications; no major difference appears when considering out-patients consultations and day-care treatments. In conclusion, a significant rise in resource utilization and in related costs may be anticipated as a consequence of the increasing prevalence of HIV encephalopathy. Further studies seem necessary to compare different approaches in the management of this debilitating disease, in view of a more rational utilization and allocation of resources.

AIDS Dementia Complex↗