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At least 721 records · Page 40Linked to original sources
PubMed2000

Clinical quality management in rheumatoid arthritis: putting theory into practice. Swiss Clinical Quality Management in Rheumatoid Arthritis.

Clinical quality management (CQM) in rheumatoid arthritis (RA) aims to reduce inflammatory activity and pain in the short term, and damage, and consequently disability, in the long term. Within CQM as used in Switzerland rheumatologists are provided with a measurement feedback system with which they can regularly follow their patients. Inflammatory activity is measured with the Disease Activity Score (DAS28) and the Rheumatoid Arthritis Disease Activity Index questionnaire (RADAI), damage with an X-ray score and disability with the Stanford Health Assessment Questionnaire (HAQ). Feedback is used to optimize therapy, which in the short term allows the activity of the inflammatory process to be adjusted or 'titrated'. In the long term, the therapy result for the individual patient is monitored by the course of disability and damage. In this paper we present a series of cases to illustrate the usefulness of the CQM system in the management of individual RA patients. CQM in RA may be helpful when making decisions about adjustment of treatment, and to document and communicate these decisions based on quantitative data.

Arthritis, Rheumatoid↗
PubMed2006

Managing resources in a better way: a new financial management approach for the University of Michigan Medical School.

Responding to changing trends in how the University of Michigan Medical School (UMMS) has been traditionally financed and anticipating that these trends will continue, in 2002 the executive leadership at the UMMS embarked upon a course designed to change not only the school's financial structure but its management culture as well. Changing traditional ways of thinking about budgets and developing a set of key performance indicators that demonstrate how certain activities shape the use of resources has brought greater understanding of how to optimize those resources to the greatest extent. Through internally developed Web-based software applications called M-STAT, M-DASH and M-ALERT (which are strategic reporting tools that the author describes), the UMMS now can manage resources in a completely different way. These tools are used to spot general financial trends or examine a more specific financial element (such as trends in grant funding or clinical activity), track the utilization of research space, calculate the break-even cost of research space, and most important, model various "what-if" scenarios to help plan effectively for the future needs of the UMMS. The strategic reporting system is still being integrated throughout the UMMS, so there has not yet been time to measure the system's efficacy or its shortcomings. Nevertheless, important lessons have already been learned, which the author presents.

Costs and Cost Analysis↗
PubMed2000

Cholesterol management: an opportunity for nurse case managers.

There is compelling scientific evidence that the modification of cardiovascular risk factors, including hypercholesterolemia, can reduce the incidence of myocardial infarction, effectively extend survival, decrease the need for interventional procedures, and improve quality of life in persons with and without known cardiovascular disease. Unfortunately, neither the publication of results from clinical trials of cholesterol lowering alone nor the 1993 National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPII) updated guidelines for the treatment of hypercholesterolemia have resulted in widespread changes in cholesterol management and control. Systematic nurse case management of dyslipidemias in patients with or at high risk for the development of coronary heart disease has the potential to improve compliance with NCEP-ATPII guidelines. In cooperation with physicians, nurses have the opportunity to address a major public health problem with the potential to eventually affect the more than 11 million people with coronary heart disease.

Case Management↗
PubMed1995

The integrated inpatient management model. Lessons for managed care.

The Integrated Inpatient Management Model was a 2.5-year controlled prospective trial of using a clinical information system to direct and monitor physician and hospital practice on general medicine services of an 880-bed university hospital. For the over 2,000 admissions on both a control service and the intervention service, the mean length of stay (LOS) decreased when compared with historic norms (0.68 and 0.95 days respectively; P < 0.01 for both). This difference in mean LOS represents a savings of 580 hospital days for the intervention over the control service; (95% confidence interval, 300 to 1420 days). There also was a trend for the intervention service to have fewer LOS outliers than expected (P = 0.14). Ancillary service use decreased by 17% on both control and intervention services (a trend that disappeared after the study was terminated), while other internal medicine services experienced a 29% increase in this measure of resource use. The intervention service experienced fewer preventable deaths (P = 0.04), but there were no differences in global quality of care measures, readmission and mortality rates, and patient satisfaction. This use of a clinical information system is a prototype for the systems that will be needed for all forms of managed care.

Ancillary Services, Hospital↗
PubMed1998

Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs. Information Management Work Group.

The ED of the future will require the effective integration of information technologies into clinical care. This article proposes strategies for improving information management in emergency medicine to facilitate patient care, public health surveillance, clinical research, medical education, and health care management.

Computer Systems↗
PubMed2000

Practical hospital pharmacy management: management strategies and methods.

This review deals with the practical management of hospital pharmacies based on experience in Indian Christian hospitals with capacities ranging from about 30 to 500 beds. However the standards of pharmacy management should not depend on size; they should be kept under review and improved as staff and financial considerations allow.

Christianity↗
PubMed2005

Construction waste management based on industrial management models: a Swedish case study.

This paper describes a methodology for estimating the true internal costs of construction waste, aimed at promoting environmentally friendly waste management. The study employs cost-benefit analysis, contribution margin analysis, the polluter-pays principle and a mathematical model: the model for Efficient Use of Resources for Optimal Production Economy (EUROPE), which has been introduced previously by the author for assigning industrial costs to waste. The calculations are performed on construction waste created in a case study of a building project. Moreover, waste is regarded as, in a business sense, having the same basic status as any normal industrial product, namely the 'equality principle'. Application of the methodology is suggested to create incentives for environmental and profitability improvement in construction companies and other types of industrial sectors. The results of the case study show the generation of construction waste to substantially decrease the final operating income, due to the internal shadow price cost it creates. This paper is intended to reduce the gap between the choice of waste management procedures and their economic impact, the overall objective being to accomplish an improved industrial environmental situation.

Construction Materials↗
PubMed2005

Transboundary hazardous waste management. Part I: Waste management policy of importing countries.

Mixed metal-containing waste, polychlorinated biphenyls (PCB) containing capacitors, printed circuit boards, steel mill dust and metal sludge were among the most common wastes exported from Taiwan. Before the implementation of the self-monitoring model programme of the Basel Convention (secretariat of the Basel Convention 2001) in the Asia region, Taiwan conducted a comprehensive 4-year follow-up project involving government authorities and the waste disposal facilities of the importing countries. A total of five countries and nine plants were visited in 2001-2002. The following outcomes can be drawn from these investigations. The Chinese government adopts the strategies of 'on-site processing' and 'relative centralization' on the waste management by tightening permitting and increasing site inspection. A three-level reviewing system is adopted for the import application. The United States have not signed the Basel Convention yet; the procedures of hazardous waste import rely on bilateral agreements. Importers are not required to provide official notification from the waste exporting countries. The operation, administration, monitoring and licensing of waste treatment plants are governed by the state environmental bureau. Finland, France and Belgium are members of the European Union. The procedures and policies of waste import are similar. All of the documents associated with transboundary movement require the approval of each government involved. Practically, the notification forms and tracking forms effectively manage the waste movement.

Asia↗
PubMed1994

Financial risk, accountability and outcome management: using data to manage and measure clinical performance.

As health care reform and components of managed competition begin to infiltrate the health care system, health care providers will be facing significant challenges over the next several years in responding to priorities that mandate the delivery of appropriate, comprehensive, cost-efficient high quality care. Changes in financial risk, increasing accountability, performance documentation, and outcome measurements will hold providers more responsible for the input and output of services provided. In an effort to respond to these challenges, health care providers will have to rely on integrated data systems to identify opportunities for improvement in an effort to more effectively manage and measure the impact of health care delivery as patients move through the health care system.

Competitive Medical Plans↗
PubMedDate not supplied

Future health services managers' and health information managers' views on information technology: a pilot survey.

This pilot survey examined the views of a sample of health service managers (HSMs) and health information managers (HIMs) undertaking tertiary studies about the application of information technology (IT) in health care. The survey was based on a questionnaire designed as part of a 1994 study of health service executives (HSEs) commissioned by the Australian College of Health Service Executives (ACHSE). We examined views about current and future IT expenditure, satisfaction with IT, impact of IT on quality and efficiency and the future use of electronic medical records and optical disk storage. Results identify differences and some similarities between respondent groups on these issues. The paper explores these differences and similarities and provides insight into the views held by future HSMs and HIMs.

Attitude of Health Personnel↗
PubMed2005

The domain management model--a tool for teaching and management of older adults in emergency departments.

Older adults in emergency departments (EDs) can have complicated health problems that defy straightforward diagnosis and management. Implementation of the 11 core principles in the geriatric emergency care model requires changes in care processes. The Domain Management Model (DMM) is one solution to organize care efficiently using a standard language. Its use is consistent with the geriatric model. Patients' problems are organized into one of four domains: I. Medical/Surgical Issues; II. Mental Status/Emotions/Coping; III. Physical Function; and IV. Living Environment (A. Physical, B. Social, and C. Financial). Specific geriatric cases illustrate improved communication using these standard domains. This model can educate health care staff, facilitate team care, improve flow of relevant information, improve decision making, and facilitate more meaningful interactions with patients.

Aged↗
PubMedDate not supplied

Assessment of drug therapy management and the prevalence of heart failure in a managed care population with hypertension.

OBJECTIVES: To (1) determine the prevalence of heart failure (HF) and cardiovascular risk factors within a hypertensive managed care population, (2) measure blood pressure goal attainment in patients with concurrent HF and hypertension (HTN), and (3) assess the use of drug therapy for diabetic and nondiabetic patients with concurrent HF and HTN, particularly regarding the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). METHODS: Eligible patients were identified through a review of medical and pharmacy claims data from 10 managed care organizations (MCOs) and 2 specialty medical groups (4.6 million total members) from June 1998 through July 2001. From approximately 850,000 members in the claims database identified as hypertensive, 7,226 were randomly selected for medical chart review. Of these, 6,935 medical charts had a confirmed diagnosis of HTN but not HF, and 291 (4%) had confirmed HTN and HF. The study population--291 patients with HTN and HF--provided information on demographic characteristics, prevalence of cardiovascular risk factors and relevant comorbidities, and systolic and diastolic blood pressure. Current antihypertensive therapy prescription fill rate was evaluated using pharmacy claims. RESULTS: Patients with diagnoses of HTN and HF confirmed in the medical chart (N=291) were included in the present analysis. HF prevalence among hypertensive patients was 4% (291 of 7,226). Mean age of the study patients was 68.3 years, and 52.9% of the patients were female. Key cardiovascular risk factors included gender (men and postmenopausal women) (89.3%), age > 60 years (73.5%), hyperlipidemia (47.4%), and diabetes (38.8%). Of the total sample, only 30.1% of the diabetic (34 of 113) and 26.4% of the nondiabetic (47 of 178) patients with HF had their blood pressure controlled to the goal level of < 130/85 mm Hg recommended by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the national guideline in effect at the time. Overall, 64.7% of HF patients for whom we had pharmacy claims were receiving an ACE inhibitor or an ARB. CONCLUSIONS: The study results indicate a deficit in the treatment of HTN among HF patients with and without diabetes, including failure to achieve blood pressure goals (< 130/85 mm Hg at the time of this study period). More aggressive quality improvement programs are necessary to educate providers and patients on the importance of treating blood pressure to nationally accepted goal using antihypertensives proven beneficial for hypertensive patients with HF.

Adult↗
PubMed1994

The challenge of managed care and managed competition.

Payment for health care in the United States changed rapidly during the 1980s, with the changes often identified by three-letter acronyms such as HMO, PPO, DRG, and RVS (health maintenance organization, preferred provider organization, diagnosis-related group, and relative value system). Changes are likely to be even more rapid and fundamental in the next few years. "Managed care" and "managed competition" are the principal terms being used to describe these pending changes. In this paper, we briefly present the problems that have led to changes, the changes that have occurred, the changes likely in the future, the implications of these changes for radiologists, and how radiologists can respond most effectively. We concentrate on the implications of changes for radiologists and on how radiologists can respond effectively.

Competitive Medical Plans↗
PubMed1999

Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits.

OBJECTIVE: To evaluate the effectiveness of a cluster visit model led by a diabetes nurse educator for delivering outpatient care management to adult patients with poorly controlled diabetes. RESEARCH DESIGN AND METHODS: This study involved a randomized controlled trial among patients of Kaiser Permanente's Pleasanton, CA, center who were aged 16-75 years and had either poor glycemic control (HbA1c > 8.5%) or no HbA1c test performed during the previous year. Intervention subjects received multidisciplinary outpatient diabetes care management delivered by a diabetes nurse educator, a psychologist, a nutritionist, and a pharmacist in cluster visit settings of 10-18 patients/month for 6 months. Outcomes included change (from baseline) in HbA1c levels; self-reported changes in self-care practices, self-efficacy, and satisfaction; and utilization of inpatient and outpatient health care. RESULTS: After the intervention, HbA1c levels declined by 1.3% in the intervention subjects versus 0.2% in the control subjects (P < 0.0001). Several self-care practices and several measures of self-efficacy improved significantly in the intervention group. Satisfaction with the program was high. Both hospital (P = 0.04) and outpatient (P < 0.01) utilization were significantly lower for intervention subjects after the program. CONCLUSIONS: A 6-month cluster visit group model of care for adults with diabetes improved glycemic control, self-efficacy, and patient satisfaction and resulted in a reduction in health care utilization after the program.

Adolescent↗
PubMed1996

Managing the occupational environment of managed care.

The emergence of managed care has resulted in a practice environment buffeted by rapid and sweeping changes. Shifts in philosophy and approach to payment for health care affect the nature of the service and the method of its delivery. The occupational adaptation frame of reference is used to illustrate the challenges imposed by the physical, social, and cultural components of the changing occupational environment. Perceptions, observations, and concerns of middle level occupational therapy, physical therapy, social work, and nursing managers illustrate the impact of this new environment. Therapists are challenged to understand their own changing work setting and to apply the same effort to mastering its challenges as they would to examining the context of their patient's occupational performance and to designing and implementing an appropriate clinical intervention.

Health Services Needs and Demand↗
PubMed1991

Managing unofficial inventory: a piece of the materiel management foundation.

The implementation plan will remain the same: target an area of opportunity, measure and document the amount and value of the unofficial inventory, establish PAR levels, implement the use of hand-held terminals to assist in inventory control, and integrate inventory control with the implementation of new programs that will impact ordering, receiving, distribution, and invoicing. It is anticipated that the inventory in the main OR alone can be reduced by $1.5 million if we move forward with a stockless JIT system. This would reduce the days of inventory on hand from approximately 100 days to between 7 and 14 days. This could also mean a holding cost reduction of $150,000. The merit of reducing unofficial inventory is evident. Managing unofficial inventory is merely one piece of the successful materiel management foundation. The other foundation pieces include contract compliance and price negotiations, systematic methods of ordering products, and timely distribution of products to the end user. PHS cannot effectively move forward to a new, innovative materiel system for the future until we first measure, analyze, and document the present conditions. Once the foundation is laid by improving present business practices, then the framework of the structure can be designed and constructed. The goal is to implement a system that utilizes the full potential of people, equipment, logistics, and information so that our customers, the patient caretakers, do not have to worry about anything except the delivery of quality care.(ABSTRACT TRUNCATED AT 250 WORDS)

Electronic Data Processing↗
PubMed1991

Special report. Integrating managed care. When managed care is a system.

In a comprehensive managed care system, all participants benefit from the improved quality and cost efficiency. When payers, beneficiaries, and providers communicate, share data, and participate in decision making, the result is more appropriate and more cost-efficient care. The following articles take a look at how each player in the health care system benefits from a comprehensive approach to health care. Payers (employers) benefit by being able to track the cost effectiveness of their health care through integrated data systems. Beneficiaries (employees and dependents) benefit by becoming more involved in the decisions being made by providers and third party payers about their care through patient education and advocacy programs. And health care providers benefit by gaining an increased leadership role in directing the management of their patients' care through practice guidelines. These guidelines will help doctors make decisions that lead to high quality care as well as build a foundation for standardized review criteria throughout the industry.

Clinical Protocols↗