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PubMed1994

The organization of statistical activities at medical research institutions.

In this paper, we discuss the organizational structure for the conduct of statistical activities at medical Colleges and Universities. Here, we have particularly focused on two significant statistical activities, i.e., statistical consultation and research. The consulting service for medical researchers consists of practical statistical analysis, instruction on computer manipulation and software, response to reviewer's comments and statistical design of prospective studies. From our various experiences, we describe the actual implementation of statistical consultations for medical researchers. It has played an important role in supporting medical research. In addition, we also outline some research, with respect to new ways of applying statistics in medical science. This paper concludes that it may be practical for the existing computer center or department of medical informatics, in charge of the computing service, to conduct statistical activities until formal organizations are established at the academic institution. To realize the conduct of statistical activities by Department of Medical Informatics, it needs a team of biostatisticians, data analysts and computer personnel.

Computer Systems↗
PubMed1976

Medicare in Quebec.

A provincial health insurance system was introduced through Canada more than five years ago. The program and fee schedules for optometric and some ophthalmologic services are presented. Statistics are provided by the government concerning the utilization of optometric and some medical eye services according to the distribution of age and sex in the Quebec population. Relative costs of these services as well as the incomes of health care professionals are compared. It is hoped that this information will aid in the planning and development of the U.S. Medicare program.

Adolescent↗
PubMed2002

Pharmacy benefit management contracting: an assessment from a recent public sector procurement experience.

In order to contain the cost of pharmaceuticals while preserving access to medically necessary drugs, Georgia state government competitively selected a single vendor in May of 2000 to manage combined pharmacy benefits under all of the state's health programs. By initiating this procedure, it intended to maximize the state's purchasing power and improve efficiency while streamlining the administrative structure. Synthesizing information from the request for proposal (RFP) and technical proposals submitted by 11 pharmacy benefit managers (PBMs) in response, we describe a model of public sector PBM contracting approach and present an assessment of the industry's service capability and performance statistics. Payers who have been using PBM services may find it interesting to compare their experience with the recent Georgia experience. Those who are considering contracting with a PBM will find the assessment of the PBM industry timely and informative.

Competitive Bidding↗
PubMed2001

A latent variable model of evidence-based quality improvement for substance abuse treatment.

Attempts to improve the quality of substance abuse treatment are hampered by an inability to define specifically the elements of high quality of care and, more important, the lack of a research paradigm within which to study the necessary and sufficient elements of appropriate care. This study proposes that the quality-of-care (QOC) construct for substance abuse treatment might be best considered as a latent construct that does not necessarily exist as a single set of criteria but instead is indicated by a set of empirically derived indicators manifested as a latent factor. Results support defining latent QOC variables across levels of care for alcoholism treatment and empirically defining latent QOC measures from administrative records.

Alcoholism↗
PubMed1975

Regional variations in the development of illness in Finland.

The aim of the present study is to investigate the incidence of morbidity leading to incapacity for work in the working age population of Finland, and to examine critically the development of such illness and variations between different population groups. An attempt is made to analyse to what extent regional differences in illness development are connected with the communal structure of an area and the provision and use of medical services. The material is based on data from the sickness insurance and national penisons, and mortality statistics. The variables used as those defined by Kalimo (1967; 1968) to describe the various features of community structure and the supply of medical services, and data from the insurance and hospital service statistics to measure the use of medical services. The results indicate considerable variation in the course of illnesses between population groups, as expressed as the incidence rates for the various phases of illness or as development probabilities. Illness development proved to be more unfavourable in men than in women. Large regional differences were found, with the course of illnesses appearing to be much more unfavourable in the eastern and northern parts of Finland than in the south and south west. This seems to be closely connected with poorer socioeconomic development and lower urbanization in an area. A clear correlation was found between illness development and the supply and use of medical services in ambulatory care. Illness development was particularly unfavourable in areas where the supply and use of ambulatory medical services, especially doctors' services, were poor. No corresponding correlation was found with the supply and use of hospital services. Development of sickness proved to be connected with a neglect of illnesses at an early phase and delay in seeking medical care. The result is confirmed by variations between population groups in the numbers of sickness benefits awarded. It was confirmed that morbidity resulting in incapacity for work is closely associated with local socioeconomic development.

Adolescent↗
PubMed2002

Using chaos theory: the implications for nursing.

AIMS OF THE PAPER: The purpose of this paper is to review chaos theory and to examine the role that it may have in the discipline of nursing. BACKGROUND: In this paper, the fundamental ingredients of chaotic thinking are outlined. The earlier days of chaos thinking were characterized by an almost exclusively physiological focus. By the 21st century, nurse theorists were applying its principles to the organization and evaluation of care delivery with varying levels of success. Whilst the biological use of chaos has focused on pragmatic approaches to knowledge enhancement, nursing has often focused on the mystical aspects of chaos as a concept. CONCLUSIONS: The contention that chaos theory has yet to find a niche within nursing theory and practice is examined. The application of chaotic thinking across nursing practice, nursing research and statistical modelling is reviewed. The use of chaos theory as a way of identifying the attractor state of specific systems is considered and the suggestion is made that it is within statistical modelling of services that chaos theory is most effective.

Humans↗
PubMed2004

The effects of organization on medical utilization: an analysis of service line organization.

OBJECTIVES: To determine whether clinical service lines in primary care and mental health reduces inpatient and urgent care utilization. METHODS: All VHA medical centers were surveyed to determine whether service lines had been established in primary care or mental health care prior to the beginning of fiscal year 1997 (FY97). Facility-level data on medical utilization from Veterans Health Affairs (VHA) administrative databases were used for descriptive and multivariate regression analyses of utilization and of changes in measures between FY97 and FY98. Nine primary care-related and 5 mental health-related variables were analyzed. PRINCIPAL FINDINGS: Primary care and mental health service lines had been established in approximately half of all facilities. Service lines varied in duration and extent of restructuring. Mere presence of a service line had no positive and several negative effects on measured outcome variables. More detailed analyses showed that some types of service lines have statistically significant and mostly negative effects on both mental health and primary care-related measures. Newly implemented service lines had significantly less improvement in measures over time than facilities with no service line. CONCLUSIONS: Health care organizations are implementing innovative organizational structures in hopes of improving quality of care and reducing resource utilization. We found that service lines in primary care and mental health may lead to an initial period of disruption, with little evidence of a beneficial effect on performance for longer duration service lines.

Efficiency, Organizational↗
PubMedDate not supplied

[Coping with the toll of heroin: 10 years of the Barcelona Action Plan on Drugs, Spain].

INTRODUCTION: The epidemic of heroin use began in Barcelona, as in the rest of Spain, in the late 70's, to reach its peak by the end of the 80's. In a first period, responsible officers experimented difficulties to define the specific objectives of opiate control policies. This paper reviews the effects of the adoption of an explicit policy on drug dependence grounded on a wide consensus in the City of Barcelona (Catalonia, Spain). SUBJECTS AND METHODS: Over a period of twelve years, from 1986 to 1997, both demand and offer of care and harm reduction services were analyzed, as well as the evolution of the adverse effects of drug use, such as mortality from acute adverse drug reaction, human immunodeficiency virus (HIV) infection, aids incidence, and incidence of tuberculosis. Data for city residents was compared through four different stages in this period. RESULTS: Despite the lack of data in initial years, relevant changes are apparent. Treatment offer changes clearly, with significant increases in initial treatment, coverage of methadone maintenance programmes, and sterile syringes distribution. Therapeutic compliance of tuberculous intravenous drug users IVDU and risk of HIV infection improve. Emergency service use linked to heroin, overdose, or withdrawal syndrome decreases. Mortality rates decline, although this decline does not reach statistical significance. DISCUSSION: Service offer shows a clear increase, reflected in treatment initiation, while harm reduction services expand. With the development of this process, outcome indicators change, both reflecting changes in the toll of the heroin epidemic (cases of tuberculosis and aids among IVDUs, HIV infection). and changes in a more comprehensive care (better treatment compliance of IVDUs with tuberculosis). There is a lower distortion of emergency services. These changes occur although the predominance of white heroin in Barcelona favors parenteral use.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Gap analysis of health services. Client satisfaction surveys.

1. Measurement of client satisfaction is an important component of an effective occupational health service. The key to providing an effective health service is meeting or exceeding what clients expect from the service. 2. Gap analysis, a methodology for measuring service quality gaps, consists of identifying the type of gap(s) (1 through 5) that exist, preventing client satisfaction with the service(s) provided. 3. Although it has limitations, the SERVQUAL instrument is a valid and reliable tool that can be adapted to measure service quality gaps in occupational health services.

Data Interpretation, Statistical↗