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PubMed1994

Resource utilization in home health care: results of a prospective study.

Resource utilization in home health care has become an issue of concern due to rising costs and recent initiatives to develop prospective payment systems for home health care. A number of issues remain unresolved for the development of prospective reimbursement in this sector, including the types of variables to be included as payment variables and appropriate measures of resource use. This study supplements previous work on home health case-mix by analyzing the factors affecting one aspect of resource use for skilled nursing visits--visit length--and explores the usefulness of several specially collected variables which are not routinely available in administrative records. A data collection instrument was developed with a focus group of skilled nurses, identifying a range of variables hypothesized to affect visit length. Five categories of variables were studied using multiple regression analysis: provider-related; patient's socio-economic status; patient's clinical status; patient's support services; and visit-specific. The final regression model identifies 9 variables which significantly affect visit time. Five of the 9 are visit-specific variables, a significant finding since these are not routinely collected. Case-mix systems which include visit time as a measure of resource use will need to investigate visit-specific variables, as this study indicates they could have the largest influence on visit time. Two other types of resources used in home health care, supplies and security drivers, were also investigated in less detail.

Boston↗
PubMed2000

Identifying office resource needs of Canadian physicians to help prevent, assess and treat patients with substance use and pathological gambling disorders.

A study was conducted to determine whether there is a need for office-based resources to assist physicians in the prevention, assessment and/or management of patients, self and peers with substance use (excluding alcohol and tobacco) or pathological gambling disorders. The needs assessment was undertaken in three parts. Survey information was collected from 54 respondents including Executive Directors of the Canadian Medical Association's national affiliates and provincial/territorial Divisions, Deputy Ministers of Health, Registrars of provincial/territorial licensing bodies and Deans or Associate Deans of Continuing Medical Education programs in universities. Key informant interviews were conducted with 22 "experts" in the field of substance use and/or pathological gambling disorders. Focus groups were held in Vancouver, Toronto, Ottawa, Montreal and Halifax with 34 physicians who are interested in and whose caseload included patients with substance use and/or gambling disorders. Results suggest that current resources for both substance use and pathological gambling disorders are inadequate for physicians because there are gaps in the types activities and resources available, existing resources have not been effectively diffused or disseminated to physicians and training is needed to complement these resources to encourage proper implementation.

Canada↗
PubMed1998

Measuring resource use in the ICU with computerized therapeutic intervention scoring system-based data.

BACKGROUND AND OBJECTIVE: In this era of health-care reform, there is increasing need to monitor and control health-care resource consumption. This requires the development of measurement tools that are practical, uniform, reproducible, and of sufficient detail to allow comparison among institutions, among select groups of patients, and among individual patients. We explored the feasibility of generating an index of resource use based on the Therapeutic Intervention Scoring System (TISS) from hospital electronic billing data. Such an index is potentially comparable across institutions, allows assessment of care at many levels, is well understood by clinicians, and captures many of the resources relevant to the ICU. DESIGN: We developed an automated mapping of the hospital billing database into the different items of TISS and generated computerized active TISS scores on 1,372 ICU days. The computerized score was then validated by comparison to prospectively gathered active TISS scores by trained data collectors. SETTING: Eight ICUs within a university teaching institution. PATIENTS: We studied 1,229 general medical and surgical ICU patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Active TISS scores ranged from 0 to 31 points. The two scores were well correlated (R2=0.53) and highly calibrated (as assessed by regression of active TISS on mean computerized active TISS [R2=0.85]). The scores were identical on 756 days (55.6%) and differed by < or = 3 TISS points on an additional 387 (28.2%) days. Interreliability assessment suggested substantial agreement (kappa statistic=0.71). The discriminatory power of the computerized score to identify different levels of ICU resource use was excellent as assessed by area under the receiver operating characteristics curves at four threshold points (0.91, 0.87, 0.89, and 0.88). Performance of the computerized score was similar across medical, coronary, and surgical ICU patient groups. CONCLUSION: An automated algorithm can reproduce valid TISS scores from standard hospital billing data, allowing comparison of patients and groups of patients in order to better understand ICU resource use.

Accounting↗
PubMed2006

Addressing resource allocation issues in recommendations from clinical practice guideline panels: suggestions from an American College of Chest Physicians task force.

Most panels that develop clinical practice guidelines are poorly equipped to address resource allocation or cost issues associated with management options. This risks neglect, arbitrariness, lack of transparency, and methodological flaws in consideration of resource allocation. We provide recommendations for guideline panels to promote greater transparency and rigor. We suggest focusing on resource allocation issues for only a limited number of recommendations and provide criteria for selecting those in which economic considerations are likely to influence the direction or strength of the recommendation. Panels should involve a health economist to assist with the systematic review and critical interpretation of relevant economic analyses. They should carefully define the intended audience and may consider issuing alternative recommendations when available resources vary widely across target clinical settings. Targeting a limited number of recommendations for the consideration of resource allocation issues, and ensuring methodologically high-quality review, will best serve guideline panels, and the health-care providers and patients they hope to assist.

Advisory Committees↗
PubMedDate not supplied

[Mechanisms for allocating financial resources after decentralization in the state of Jalisco].

OBJECTIVE: To analyze, from the decision maker's perspective, the financial resource allocation process of the health services of the state of Jalisco (SSJ, per its abbreviation in spanish), within the context of decentralization. MATERIAL AND METHODS: Through a qualitative approximation using semi-structured individual interviews of key personnel in managerial positions as the method for compiling information, the experience of the SSJ in financial resource allocation was documented. From September to November 2003, the perception of managers and administrators regarding their level of autonomy in decision-making was explored as well as the process they follow for the allocation of financial resources, in order to identify the criteria they use and their justifications. RESULTS: From the point of view of decision-makers, autonomy of the SSJ has increased considerably since decentralization was implemented, although the degree of decision-making freedom remains limited due mainly to high adminstrative costs associated with salaries. In this sense, the implications attributable to labor situations that are still centralized are evident. Some innovative systems for financial resource allocation have been established in the SSJ for the sanitary regions and hospitals based upon administrative-managerial and productivity incentives. Adjustments were also made for degree of marginalization and population lag, under the equity criterion. CONCLUSIONS: General work conditions and decision-making autonomy of the sanitary regions constitute outstanding aspects pending decentralization. Although decentralization has granted more autonomy to the SSJ, the level of decision-making freedom for allocating financial resources has been held within the highest hierarchical levels.

Delivery of Health Care↗
PubMed2005

[Home health resource utilization measures using a case-mix adjustor model].

PURPOSE: The purpose of this study was to measure home health resource utilization using a Case-Mix Adjustor Model developed in the U.S. METHOD: The subjects of this study were 484 patients who had received home health care more than 4 visits during a 60-day episode at 31 home health care institutions. Data on the 484 patients had to be merged onto a 60-day payment segment. Based on the results, the researcher classified home health resource groups (HHRG). RESULT: The subjects were classified into 34 HHRGs in Korea. Home health resource utilization according to clinical severity was in order of Minimum (C0) < 'Low (C1) < 'Moderate (C2) < 'High (C3), according to dependency in daily activities was in order of Minimum (F0) < 'High (F3) < 'Medium (F2) < 'Low (F1) < 'Maximum (F4). Resource utilization by HHRGs was the highest 564,735 won in group C0F0S2 (clinical severity minimum, dependency in daily activity minimum, service utilization moderate), and the lowest 97,000 won in group C2F3S1, so the former was 5.82 times higher than the latter. CONCLUSION: Resource utilization in home health care has become an issue of concern due to rising costs for home health care. The results suggest the need for more analytical attention on the utilization and expenditures for home care using a Case-Mix Adjustor Model.

Adult↗
PubMed1994

Hospital resource allocation.

Good resource allocation is essential to effective hospital cost management. Yet current allocation methods are weak, and the damage done by bad allocations cannot be undone with utilization fine-tuning. The three traditional methods are resource-allocation-by-momentum (RAM); resource-allocation-by-physician (RAP); and resource-allocation-to-survive (RAS). As hospitals change, a new allocation method is needed: resource-allocation-in-response-to-need (RARN). To determine appropriate allocations, RARN analyzes each activity based upon community need, hospital response, and economics. RARN balances cost management emphasis of doing things right (utilization) with doing the right things (allocation).

Cost Control↗
PubMed1997

Healthcare resource management: integrating apples and oranges.

Over the past several years this journal has published numerous articles on the merits and benefits of effective resource management. Independently, these articles have supported the value of effective supply and materials management, management engineering and system restructuring, and clinical resource management in being able to save healthcare dollars by designing and injecting efficiencies into the healthcare delivery system. While most of these resource management activities have utilized very similar strategies (see Table 1 "Tools For Improvement"), much of the process revision and progress has remained within the walls of their own individual disciplines. Any widescale attempts to try to fully integrate all of these activities have been hampered by the intricacies of trying to mix apples and oranges. Despite these individual departmental gains, the challenge to conserve healthcare costs continues to permeate throughout all levels of the organization, and institutions are finally beginning to recognize the added value of merging these activities into a more centralized coordinated approach to resource management. Presented is a discussion on the potential value of developing a well-focused, integrated resource management program.

Benchmarking↗
PubMed1997

The validity and usage of resource utilization data among a group of primary care physicians.

The use of individual resource utilization scores to compare primary care physicians (PCPs) has become more commonplace as managed care organizations (MCOs) increase their penetration into the US healthcare market. This study looks at the validity and usage of these scores among a group of PCPs within a multispecialty clinic that is part of an integrated managed care network. Personal interviews were conducted with PCPs; and reviews were done of the practice site paper charts, the computerized visit record system of the clinic and affiliated hospital, and the MCO-supplied resource utilization data on the 25 patients of each PCP on whom the most healthcare dollars were spent in 1995. As of October 1996, few PCPs had done more than a cursory review of their resource utilization data. None had identified the patients who use the most resources or developed any methods to proactively manage those patients with a history of high utilization. The clinic's communication systems alerted the PCPs less than 50% of the time when patients for whom they were responsible had high utilization of services. Patients appeared to be assigned to the incorrect PCP more than 20% of the time. All players in this managed care network--PCPs, clinic administration, and the MCO--must work together to improve the current system before resource utilization data are considered valid and are incorporated more fully into clinical practice.

Efficiency, Organizational↗
PubMed1998

Application of geographical information systems to co-analysis of disease and economic resources: dengue and malaria in Thailand.

Two vector-borne communicable diseases, malaria and dengue, are among a number of diseases of particular importance in relation to economic development in Southeast Asia and thus need to be assessed in relation to economic parameters in the region. Geographical Information Systems (GIS) provide one means of comparing disease and resource data versus time and place, to facilitate rapid visualization by planners and administrators. Given that Thailand is a global epicenter of multidrug resistant falciparum malaria and of dengue hemorrhagic fever, both of which are mosquito-borne, application of GIS methods to these two diseases gives opportunity for comparison of resource needs and allocation in relation to disease epidemiologic patterns. This study examined per capita gross provincial product (GPPpc) and health care resources in relation to geographic distribution of malaria and dengue in Thailand. The two diseases vary greatly in overall seasonal patterns and in relation to provincial economic status, and present differing demands on resource utilization: planned integration of control of malaria and dengue could utilize such analyses in relation to resource sharing and consideration of allocative efficiency. The concentration of malaria (and to a lesser extent dengue) along international border areas underscores the desirability of multi-country coordination of disease management and control programs. Because socio-economic and disease data are collected by quite different means and in different time frames, there are some limitations to the dynamic interpolation of these two broad data sets, but useful inferences can be drawn from this approach for application to overall planning, at both national and multi-country levels.

Dengue↗
PubMed2000

A trauma resource allocation model for ambulances and hospitals.

OBJECTIVE: To develop a mathematical model for the location of trauma care resources. DATA SOURCES/STUDY SETTING: Severely injured patients queried from Maryland hospital discharge and vital statistics data. A spatial injury profile was created by parsing these patients into ZIP codes. STUDY DESIGN: The Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) was formulated using integer and heuristic programming. To maximize coverage of severely injured patients, trauma centers and aeromedical depots were simultaneously sited using TRAMAH. A severe injury was considered covered if at least one trauma center was sited within a time standard by ground, or if an aeromedical depot-trauma center pair was sited in such a way that the sum of the flying time from the aeromedical depot to the scene of injury plus the flying time from the scene of injury to the trauma center was within the same time standard. PRINCIPAL FINDINGS: From 1992 to 1994, 26,774 severe injuries were considered for coverage. Across Maryland, 94.8 percent of severely injured residents had access to trauma system resources within 30 minutes and 70.3 percent had access within 15 minutes. For the same number of resources as the existing Maryland Trauma System, TRAMAH achieved a coverage objective of 99.97 percent within 30 minutes. This translated into an additional 461 severely injured people covered each year. Holding in place the trauma centers of the existing system, approximately the same percentage of coverage as that of the existing system was achieved within 15 minutes by optimally locating six fewer aeromedical depots. CONCLUSIONS: TRAMAH will allow trauma systems planners to better locate their resources with respect to spatial needs and response times.

Air Ambulances↗
PubMed1999

Using activity-based costing to track resource use in group practices.

Research shows that understanding how resources are consumed can help group practices control costs. An American Academy of Orthopaedic Surgeons study used an activity-based costing (ABC) system to measure how resources are consumed in providing medical services. Teams of accounting professors observed 18 diverse orthopedic surgery practices. The researchers identified 17 resource-consuming business processes performed by nonphysician office staff. They measured resource consumption by assigning costs to each process according to how much time is spent on related work activities. When group practices understand how their resources are being consumed, they can reduce costs and optimize revenues by making adjustments in how administrative and clinical staff work.

Accounting↗
PubMed2001

The Cooperative Breast Cancer Tissue Resource: archival tissue for the investigation of tumor markers.

Investigators continue to search for reliable markers of prognosis of breast cancer. For many analyses, laboratory techniques permit the use of archival paraffin-embedded tissue collected years previously and readily linked to clinical and follow-up information. Laboratory investigators have often expressed the need for such a tissue resource. We have developed a publicly available resource of archival breast cancer specimens. The pathological material has been collected and reviewed by investigators at four institutions and currently includes breast cancer specimens from more than 9300 cases. Institutional pathologists reviewed slides and blocks using a common protocol and coding scheme. Clinical information and details of follow-up came from data routinely collected by the institutions' cancer registries. Coded data are maintained centrally in a single database. A subset of the data may be searched on the World Wide Web to determine the availability of cases with specified characteristics. The material collected by this Cooperative Breast Cancer Tissue Resource is generally representative of breast cancer diagnosed in community hospital settings in the United States. Seventy-two percent of the living cases have been followed for at least 5 years, and follow-up status is updated regularly. Interested laboratory investigators may apply to the Resource for the use of these tissues. This Resource is proving valuable to laboratory investigators who require large numbers of specimens for validation studies of prognostic markers of breast cancer.

Adult↗
PubMed2001

Gendered health resources and coping--a study from general practice.

AIM: The aim of this study was to explore gender and coping in primary health care patients, by comparing self-assessed health resources in men and women. METHODS: Female and male patients' self-assessed health resources were identified by mean of key questions, developed separately for men and women. Patients' answers were audiotaped and analyzed qualitatively. An explorative gender comparative analysis was done. The setting comprised two women GPs and their consultations. The subjects were 37 consecutive female patients and 39 consecutive male patients aged 19-85 years. RESULTS: The analysis indicated notable differences in spite of apparent similarities in self-assessed personal health resources in men and women. In men, personal strength was part of a proud identity, while women reported that they were able to manage because they just had to. Work was often mentioned as a health resource, but while men emphasized their well-being at work and a capacity to relax at home, women handled stressful tensions by diving into household activities. While men spoke of gaining health from being with others, women talked about social relations as contexts for gaining as well as giving health. CONCLUSION: None of the phenomena described by the respondents can be reasonably categorized as respectively problem-focused, emotion-focused or avoidance coping strategies. Asking people about their own ideas regarding health resources may provide more complex understandings of coping and gender. In a clinical setting skilful listening can prevent gender essentialism, where all men are regarded as different from all women.

Adaptation, Psychological↗
PubMed2002

Reflection on the history, coordination, and funding trends for U.S. public meat research: information to enhance resource allocation.

A study was conducted to analyze resource allocation for public meat research in the United States and characterize the portfolio of meat research investments. Trends in the amount of public resources provided for meat research (beef, pork, lamb, and poultry) were analyzed for fiscal years 1980, 1985, 1990, 1995, and 1997. An in-depth analysis was conducted for data from fiscal year 1998 to characterize the profile of the research portfolio. Funding levels and scientist-year equivalents were aggregated to represent the measures of resource allocation for three mutually exclusive research categories: 1) meat quality, 2) food safety, and 3) product development and processing. Data for the 1998 profile analysis were derived from a computer search based on the combination of key words and research classification codes to avoid duplication and cluster research projects. Individual research projects were individually reviewed and a percentage was assigned to four mutually exclusive research categories: 1) meat quality, 2) food safety, 3) product development and processing, and 4) marketing. As meat research evolved over the past century, considerable efforts were expended by researchers and administrators to ensure the coordination of research and program relevance. This is demonstrated by the establishment of numerous multistate research committees. Total funding for meat science increased only modestly when adjusted for inflation during the two decades of this study; however, notable changes occurred in the distribution of resources in the portfolio. Funding for meat quality and product development and processing remained virtually unchanged when adjusted for inflation, whereas funding for food safety increased considerably. The total number of scientists conducting meat research remained virtually unchanged during the period, but the proportion allocated to food safety research increased substantially. The federal portion of total funding decreased from 61.3% to 51.6% between 1980 and 1997, whereas the percentage from both state appropriations and private sources increased. Modifications in research emphasis were influenced by industry problems such as meat quality, public perceptions about food safety, the availability of research funding, scientific advances occurring in molecular biology and genetic manipulation, and the changing meat industry. The information in this paper provides administrators and researchers the opportunity to make better informed decisions about resource allocation for meat research.

Advertising↗
PubMed2003

[A tool to predict the resources necessary for the whole hemodialysis population].

Predicting the resources necessary for the treatment of terminal renal insufficiency requires an understanding of the needs of the whole dialysis population. This study evaluates the advantages of a complete evaluation grid for care needs (CG, 47 items) compared with a simplified version (SG) and with the data obtained from REIN (R) as a tool for predicting the required resources. Compared to CG, the two other classifications under-estimate the level of care needed and the prevalence of patients who have at least one condition resulting in an 'excess' of needs. In a system with three types of structures, the theoretical distribution of patients according to the CG is: in structure A (permanent medical presence): 43.4% (vs 39 for SG and 21% for R); in structure B (intermediate): 34% (vs 31.5 and 24.7% respectively); and in structure C (independent): 22.3% (vs 29.5 and 53.5%) of patients. The care needs scores of populations assigned by R to home dialysis are incompatible with the resources allocated to it. With a certain number of adjustments and qualifications, a population study using a simplified needs grid could enable a prediction of the resources which need to be provided. The patients' records which take precedence in the future REIN should be modified in order to make possible a regular evaluation of the appropriateness of the resources allocated.

Adult↗
PubMed2003

[Barriers to the fair allocation of healthcare resources].

The gap between infinite healthcare needs and finite health resources imposes on practicing physicians a dual commitment to patients' needs and to the fair allocation of health care resources. The ethical principles of a fair allocation of resources are egalitarianism, utilitarianism and a transition from individual to group-based ethics. These principles are ambiguous and occasionally conflicting. Their implementation is further impeded by practice norms, such as private practice by physicians employed by public institutions, incentives for physicians to save, and marketing of clinical interventions of unproven efficacy. Proposed approaches to these barriers to the fair allocation of resources include respect of patient autonomy with full disclosure of the limitations in the services provided by the health plan; adherence to clinical practice guidelines; and an open access for patients to second medical opinion. I believe that the fairness of resource allocation may be further improved by the prohibition of private practice by physicians employed in public health care institutions, and by enhancement of physicians' self-awareness of subconscious discrimination against some patients.

Delivery of Health Care↗
PubMedDate not supplied

African American caregivers and HIV/AIDS formal resources.

The African American community continues to be disproportionately affected by the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in many ways. In addition to the prevalence rates of the disease in the community, caregivers of people living with HIV/AIDS continue to be challenged as they strive to provide care and support to love ones. The purpose of this pilot study is to explore how African American caregivers of adults living with HIV/AIDS engage available formal resources within their community. African American caregivers (N = 10) were recruited from Long Island, New York and interviewed using unstructured and semi-structured questions. The caregivers' use of community resources were associated with circulating communication within the community about the resource. For example, formal (health & social) resources were recommended and/or accessed if the resource had a positive, historical past of rendering culturally sensitive and medically competent care to the African American community. Recommendations for further study and community- level implications for health care professionals are suggested.

Adult↗