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PubMed2006

The costs of planned cesarean versus planned vaginal birth in the Term Breech Trial.

BACKGROUND: The Term Breech Trial compared the safety of planned cesarean and planned vaginal birth for breech presentations at term. The combined outcome of perinatal or neonatal death and serious neonatal morbidity was found to be significantly lower among babies delivered by planned cesarean section. In this study we conducted a cost analysis of the 2 approaches to breech presentations at delivery. METHODS: We used a third-party-payer (i.e., Ministry of Health) perspective. We included all costs for physician services and all hospital-related costs incurred by both the mother and the infant. We collected health care utilization and outcomes for all study participants during the trial. We used only the utilization data from countries with low national rates of perinatal death (< or = 20/1000). Seven hospitals across Canada (4 teaching and 3 community centres) were selected for unit cost calculations. RESULTS: The estimated mean cost of a planned cesarean was significantly lower than that of a planned vaginal birth (7165 dollars v. 8042 dollars per mother and infant; mean difference -877 dollars, 95% credible interval -1286 dollars to -473 dollars). The estimated mean cost of a planned cesarean was lower than that of a planned vaginal birth for both women having a first birth (7255 dollars v. 8440 dollars) and women having had at least one prior birth (7071 dollars v. 7559 dollars). Although the treatment effect was largest in the subgroup of women having their first child, there was no statistically significant interaction between treatment and parity since the 95% credible intervals for difference in treatment effects between parity equalling zero and parity of one or greater all include zero. INTERPRETATION: Planned cesarean section was found to be less costly than planned vaginal birth for the singleton fetus in a breech presentation at term in the Term Breech Trial.

Adult↗

PubMed2005

Adjusting Pediatric Consumer Assessment of Health Plans Study (CAHPS) Scores to Ensure Fair Comparison of Health Plan Performances.

OBJECTIVES: When comparing the scores from Consumer Assessment of Health Plans Study (CAHPS) surveys across health plans, it is important to adjust for patient characteristics (casemix) that are not under the control of the plan but that affect plan ratings. Our goal was to develop casemix models for pediatric CAHPS surveys. METHODS: We analyzed responses to the pediatric CAHPS 2.0 surveys from 50,583 Medicaid beneficiaries and 43,579 persons with private health insurance. We identified patient characteristics with the most substantial impact on scores and assessed casemix models that include different combinations of adjusters. In addition, we tested whether casemix coefficients differed between the Medicaid and commercial samples and across health plans. RESULTS: Parent age and education and child health status and race were important casemix adjustment variables for pediatric CAHPS surveys. Child age and gender had smaller effects. The relationship between patient characteristics and CAHPS scores was different in the Medicaid and commercial samples for some variables. The effects of a patient's characteristics on ratings and report scores were not consistent across Medicaid plans but more consistent for commercial plans. CONCLUSIONS: Our analyses indicate that plan scores on the pediatric CAHPS survey should be adjusted for plan differences in casemix. Users should consider estimating separate models for Medicaid and commercially insured respondents. Such models should adjust for child health status, parent age, and parent education.

Adolescent↗

PubMed1995

Planning in the real world: preschool children's scripts and plans for familiar events.

3-, 4-, and 5-year-olds reported either scripts or verbal plans for 2 familiar events, going grocery shopping and going to the beach, and also constructed plans to remedy and prevent mishaps that might occur for each event. With increasing age, children reported more information, focused more on onset activities, and mentioned more specific planning activities in their plans than in their scripts. Although children at all ages provided adequate remedy plans, only 5-year-olds provided adequate prevention plans. In general, children were better at planning for the beach than for grocery shopping. Results indicate that developmental differences in event knowledge, in the ability to reflect upon event knowledge, and the event that they are planning for affect preschoolers' planning for real-world events.

Child↗

PubMed1997

Methods for transferring patient and plan data between radiotherapy treatment planning systems.

The effectiveness of conformal radiotherapy can ultimately only be assessed by the use of clinical trials. As large multicentre clinical trials become more widespread, methods of transferring patient and plan data between radiotherapy treatment planning systems become increasingly important. In this paper, the general strategy for the transfer of data is discussed, and also illustrated with reference to two specific systems: TARGET 2 (GE Medical Systems) and VOXELPLAN (DKFZ-Heidelberg). The transfer method involves using a computer program to translate the data formats used by each of the two systems for CT scans, patient outlines, plan information and block descriptions. This paper does not address the question of transferring beam data between systems: beam data must first be entered separately into both machines. The physical concepts encountered when transferring plans are described, with specific reference to the two planning systems used. Differences in the strategies used by the two planning systems for definition of irregular field shapes are compared. The dose calculations used by the two systems are also briefly evaluated. Isodoses produced by VOXELPLAN around a circular target volume are found to be up to 3 mm different in location to those produced by TARGET 2, owing to the use of a smooth field shape contour as opposed to a stepped field shape which closely models the leaves of a multileaf collimator. In general, dose distributions generated by both systems are comparable, but some differences are found in the presence of large tissue inhomogeneities. It is concluded that the transfer of patient and plan data between two different treatment planning systems is feasible, provided that any differences in field shape definition methods or dose calculation methods between the two systems are understood.

Humans↗

PubMed2003

Determinants of the use of health plan information in formulating health plan selection decisions.

This study seeks to identify the impact of information on employees' health plan selection decision-making. Surveys were administered to 1,722 Federal employees working in the Department of Health and Human Services (DHHS) enrolled in the Federal Employees Health Benefits Program (FEHBP). This study focuses on the enrollees' access to and use of three types of health plan information: print information issued by the Federal government (in particular, The Guide to Federal Employees Health Benefit Plans), print information issued by the health plans, and web-based information. Literature from health plans was utilized to a greater degree than The Guide. Web-based information was the least accessed and used. Major positive predictors of the use of health plan information from any source were: race, time in Federal employment, whether the employee was considering a plan change, employees with less time in current plan, employees who search for information to make decisions, and spouses' health status. Younger and more-educated employees were more likely to access web-based information. Implications for management, policy, and future research are discussed.

Consumer Behavior↗

PubMed1980

Health Care Financing Administration--Fiscal year 1980 regulation plan. Notice of regulation plan.

HCFA has adopted a new regulation management system which includes a process for developing a regulation plan at the beginning of each fiscal year. Each initiative in the plan is designed to achieve specific programmatic goals and objectives in accordance with priorities. The plan includes a projected schedule for publishing each regulatory initiative in priority order. The annual HCFA plan supplements the Semi-Annual Agenda of Regulations published by HHS in June and December of each year in accordance with Executive Order 12044 "Improving Federal Government Regulations" (See 43 FR 12661 published March 23, 1978), and the Department's procedures which implement the Executive Order (See 43 FR 23119 published May 30, 1978, and 44 FR 59662 published October 16, 1979). The HCFA plan includes: [1] initiatives which appear in the Semi-Annual Agenda of Regulations because HCFA and the Secretary of HHS have concluded that specific regulation changes are needed; [2] new initiatives at an early stage of consideration where HCFA and the Secretary have not yet concluded that specific regulation changes are needed; and [3] routine initiatives that provide guidelines for existing regulations. HCFA is publishing the plan to provide the public with advance notice as early as possible of regulation initiatives that are planned or under active consideration. HCFA welcomes comments on the content of the plan, the priority set for each initiative, and projected publications targets.

Financing, Government↗

PubMed1981

Social planning orientations: exercises in compliance or planned social change?

The author presents the idea that the established conceptual bases for the practice of social planning no longer apply to the circumstances that define the current planning environment. The idea is based on the observation that the practice of social planning in the public sector is primarily an exercise in complying with prescribed protocols and regulations in order to legitimize the expenditure of funds for social programs. The observation is derived from experience with four major social planning programs: Area Agencies on Aging; Community Action Programs; State Social Service (Title XX) Agencies; and Health Systems Agencies. Common experiences in these agencies suggest the need for an additional orientation to planning. A negotiated-operational orientation that is more closely aligned to the environmental conditions of the social planning experiences is described. The ability of the social planner to use this orientation as an additional frame of reference is seen as a key factor determining whether compliance or social change will be a dominant characteristic of social planning in the 1980s.

Health Planning↗

PubMed1980

Regs control the planning process as well as the plan.

Approval for hospital expansion plans rests on how much they conform to the state health plan, the health state plan, the health systems plan, and the annual implementation plan. A hospital's planning process must start with a detailed analysis of these plans.

Certificate of Need↗

PubMed2004

Intraoperative HDR brachytherapy for rectal cancer using a flexible intraoperative template: standard plans versus individual planning.

HDR intraoperative brachytherapy (IOBT) is applied to locally advanced rectal tumors using a 5 mm thick flexible intraoperative template (FIT). To reduce the procedure time, treatment planning is performed using standard plans that neglect the curvature of the FIT. We have calculated the individual treatment plan, based on the real geometry of the FIT, and the dose at clips placed during surgery. A mean treatment dose of 9.55+/-0.21 Gy was found for the individual plan, compared to the prescribed 10 Gy (P<0.0001) The mean central dose was 10.03+/-0.10 Gy in the standard plan and 9.20+/-0.32 Gy in the individual plan (P<0.0001) The mean dose at the corners of the FIT was 10.3 Gy in the standard plan and ranged between 10.3 and 10.5 Gy in the individual plan. In 63% of the clips, the dose was larger than 15.0 Gy, which is equivalent to a gap between the FIT and the target smaller than 5 mm. In 18% of the clips, the dose was smaller than 13.0 Gy indicating that locally the gap was larger than 5 mm. Clinical practice will have to prove if these small dose deviations influence the clinical outcome.

Brachytherapy↗

PubMed2004

Planning versus speed: an experimental examination of what Planned Codes of the Cognitive Assessment System measures.

This study provided validity evidence that the Cognitive Assessment System, Planned Codes subtest measures planning rather than speed. Each of 156 children completed Planned Codes using two different sets of directions. The first set of directions allowed each child to use strategies to complete Planned Codes. The second set of directions allowed the child only to use speed to complete Planned Codes. The results of the study indicated significantly higher scores (t = 11.5, P < .0001) when the child was allowed to use strategies (mean = 34.1, S.D. = 9.2) compared to the same child's score when speed (mean = 25.6, S.D. = 7.5) alone was used to complete Planned Codes. A partial correlation, with age effects removed, between the scores each child earned under the two conditions was very low (r = .23, P < .01). Calculation of the magnitude of difference between the two groups yielded an effect size of 1.0. The results of this study provided validity support that the Cognitive Assessment System Planned Codes subtest measures planning.

Child↗

PubMed2005

Mothers' views of their childbirth experiences 2 years after planned Caesarean versus planned vaginal birth for breech presentation at term, in the international randomized Term Breech Trial.

OBJECTIVE: To compare mothers' views at 2 years postpartum after participation in a randomized trial of planned Caesarean and planned vaginal birth for a singleton fetus in breech presentation at term. STUDY DESIGN: In selected centres in the Term Breech Trial, mothers completed a structured questionnaire at approximately 2 years postpartum to assess their likes and dislikes about their childbirth experiences and their views about their intrapartum care and care providers. RESULTS: Of 1159 mothers from 85 centres, 917 (79.1%) completed a follow-up questionnaire at 2 years postpartum. Baseline information was similar for both the planned Caesarean and planned vaginal birth groups. Planned Caesarean was associated with less worry about the baby's health (P < 0.001). While other differences were noted in likes and dislikes about their childbirth experiences, women's evaluations of the quality of intrapartum care, the helpfulness of staff, and their involvement in decision-making did not differ in the planned Caesarean delivery and planned vaginal birth groups. CONCLUSION: Planned mode of delivery influences aspects of women's evaluations of their childbirth experiences but does not affect evaluations of the quality of intrapartum care, support from care providers, or amount of involvement in decision-making.

Breech Presentation↗

PubMed1995

Planned abdominal compared with planned vaginal birth in triplet pregnancies.

OBJECTIVE: To compare a policy of planned abdominal delivery with a policy of planned vaginal delivery in triplet pregnancies. DESIGN: Retrospective study. SETTING: Two Dutch university hospitals, each having a different approach to the planned mode of delivery in triplet gestations. SUBJECTS: Thirty women giving birth to triplets in the hospital in Leiden, who favoured planned abdominal delivery, compared with 39 from the Medical Centre in Amsterdam who favoured vaginal delivery. MAIN OUTCOME MEASURES: Perinatal mortality and early neonatal complications. RESULTS: Both centres were equally successful in achieving their planned policies: in Leiden 80% of women were delivered by caesarean section but in Amsterdam 87% of women were delivered vaginally. Compared with vaginal delivery, planned abdominal delivery was associated with a significantly higher perinatal mortality rate (P = 0.02), primarily due to respiratory distress syndrome, and a higher recorded neonatal complication rate (P = 0.03), especially sepsis, respiratory distress syndrome, and necrotising enterocolitis. CONCLUSIONS: A policy of planned abdominal delivery in triplets is not superior to a policy of planned vaginal delivery in terms of fetal and early neonatal outcome.

Adult↗

PubMed1998

Strategic planning in hospitals in two Australian states: an exploratory study of its practice using planning documentation.

Hospitals are under pressure to respond to new challenges and competition. Many hospitals have used strategic planning to respond to these environmental changes. This exploratory study examines the extent of strategic planning in hospitals in two Australian States, New South Wales and Victoria, using a sample survey. Based on planning documentation, the study indicated that 47% of the hospitals surveyed did not have a strategic or business plan. A significant difference was found in the comprehensiveness of the plans between the two States. Plans from Victorian hospitals had more documented evidence of external/internal analysis, competitor orientation and customer orientation compared with plans from New South Wales hospitals. The paper discusses the limitations of the study and directions for future research.

Data Collection↗

PubMed1994

Permeation of organization-level strategic planning into nursing division-level planning.

This study focuses on strategic planning in 15 general hospitals in the northwest, examining the relationship between organization-level strategic planning and operating margins of profit or loss and the permeation of organization-level strategic planning into the nursing division-level planning. A small positive relationship between strategic planning and operating margins was found. Permeation of organization-level strategic planning into the nursing division planning was found in 5 of the 15 hospitals.

Decision Making, Organizational↗

PubMed2005

Treatment planning for resected abdominal tumors: differences in organ position between diagnostic and radiation-planning computed tomography scans.

PURPOSE: To evaluate whether organ location, determined from preoperative diagnostic computed tomography scans (CTs), accurately reflects organ location when patients are positioned for radiation therapy. METHODS AND MATERIALS: We identified patients with upper abdominal malignancies treated with surgery and/or radiation therapy. Comparisons of organ position relative to fixed bony landmarks were made among preoperative diagnostic CTs, postoperative diagnostic CTs, and radiation-planning CTs. We studied 18 patients who had CTs differing only in scanning technique, 11 patients who had CTs differing only in operative state, and 7 patients with CTs differing in both scanning technique and operative state. RESULTS: For patients with diagnostic CTs and radiation-planning CTs that were either both preoperative or both postoperative, mean organ position, measured relative to a fixed bony landmark, ranged from 1.9 to 3.2 cm superior on radiation-planning CTs compared with diagnostic CTs (p < 0.0001). Mean organ position ranged from 0.9 to 1.7 cm posterior on radiation-planning CTs compared with diagnostic CTs (p < or = 0.008). Shifts in the right-left direction were small and variable. For patients with pre- and postoperative diagnostic CTs, organ shifts were variable and not significant. Organ shifts for patients with preoperative diagnostic CTs and postoperative radiation-planning CTs were similar to shifts observed for the first group. CONCLUSIONS: Relative to bony landmarks, there are superior and posterior shifts in organ position for radiation-planning CTs compared with diagnostic CTs. These shifts should be considered during treatment planning for resected abdominal tumors.

Female↗

PubMed2000

Dosimetric comparison of pre-planned and or-planned prostate seed brachytherapy.

PURPOSE: To compare the dosimetry of the traditional two step procedure (volume study + treatment planning several weeks later) with that of an OR-based single procedure in which these two steps follow one another immediately. Computer generated treatment plans were used in both procedures. METHODS AND MATERIALS: Several dosimetric parameters relating to target coverage were obtained from dose volume histograms of CT-based evaluation plans developed either 1 or 3 days following seed implantation. A total of 113 patients with early stage (T1C, T2A) prostate cancer were used for this retrospective study. RESULTS: The fraction of target (prostate) covered by the prescription dose (144 Gy), 90% of the prescription dose (115 Gy), and the dose encompassing 90% of the target in the evaluation plan were all statistically significantly improved for OR-based plans compared to pre-planned cases. CONCLUSION: In our hands, there is a small but significant improvement in dose coverage of the prostate when the ultrasound volume study and treatment planning are combined into a single procedure.

Brachytherapy↗

PubMed1977

Issues in health plan development: a critique of the guidelines for plan development under PL 93-641.

The draft guidelines for development of health systems plans and annual implementation plans represent a logical, coherent integration of the best of currently available planning concepts and methods. However, there are at least six major areas in which the current state of the art is clearly inadequate. These are linkages between plan components, synchronization, plan integration, level of detail, cross-impact analyses and policy planning. This article describes each of these issues and identifies some of the projects which seem likely to contribute to their resolution. Finally, it urges each health planning agency to take advantage of the latitude in the guidelines to develop innovative solutions and to share the results with others.

Decision Making↗

PubMed2000

Planning documents: a business planning strategy.

Strategic planning and business plan development are essential nursing management skills in today's competitive, fast paced, continually changing health care environment. Even in times of great uncertainty, nurse managers need to plan and forecast for the future. A well-written business plan allows nurse managers to communicate their expertise and proactively contribute to the programmatic decisions and changes occurring within their patient population or service area. This article presents the use of planning documents as a practical, strategic business planning strategy. Although the model addresses orthopedic services specifically, nurse managers can gain an understanding and working knowledge of planning concepts that can be applied to all patient populations.

Commerce↗