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At least 757 records · Page 42Linked to original sources
PubMed1989

Impact of needs and resources on family plans to seek out-of-home placement.

The decision to maintain a severely mentally retarded child in the home or seek out-of-home placement is regarded as one aspect of family adaptation. As such, the decision is affected by numerous child-related stressors, preexistent family resources, and new sources of support. In the current study, parents with severely mentally retarded children still living at home were surveyed with regard to these variables and their plans for future child placement. Multiple regression analyses revealed that child-related stressors were negatively related to parents' plans for keeping the child at home until age 21 and positively related to plans for placing the child outside the home before age 21. Families with high levels of internal resources were more apt to report plans for keeping the child at home indefinitely. Degree of external resource use was related to plans to maintain the child at home until age 21, over-and-above both child-related stressors and family resources. Specific kinds of external resources were examined and ranked ordered with regard to their usefulness to parents in maintaining their child in the home.

Adaptation, Psychological↗
PubMed1983

Measuring severity of illness to predict patient resource use within DRGs.

We describe a new Severity of Illness Index which predicts patient resource use within DRGs and within broad diagnostic categories. Resource use is defined by total charges, length of stay, laboratory charges, radiology charges, and routine charges. Within broad diagnostic categories, the Index explains much more variation in resource utilization than do other case mix grouping methods such as DRGs, generalized patient management paths, and staging groups. Within DRGs, the Index also predicts much of the variation in resource use. We discuss use of the Index to price cases and predict resource use in a hospital.

Abstracting and Indexing↗
PubMed1995

The use of APACHE III to evaluate ICU length of stay, resource use, and mortality after coronary artery by-pass surgery.

OBJECTIVE: To identify patient characteristics that are associated with increased ICU length of stay, resource use, and hospital mortality after coronary artery bypass surgery. DESIGN: Prospective, multicenter study. SETTING: Six tertiary care hospitals. PARTICIPANTS: A consecutive sample of 2,435 unselected ICU admissions following coronary artery by-pass surgery. MATERIALS AND METHODS: Demographic, operative characteristics and APACHE III score were collected during the first postoperative day; and APACHE III scores and therapeutic interventions during the first three postoperative days. Hospital survival and ICU length of stay were also recorded. Multivariate equations were derived and cross-validated to predict hospital mortality, ICU length of stay, and ICU resource use. RESULTS: Unadjusted hospital mortality rate was 3.9% (range 1.0% to 6.0%), mean ICU length of stay was 3.7 days (range 3.2 to 4.7 days), and first 3-day ICU resource use (TISS points) was 99 (range 68 to 116). The range of actual to predicted ICU length of stay varied from 0.86 to 1.26; and resource use from 0.71 to 1.16. CONCLUSIONS: A limited number of operative characteristics, the post-operative acute physiology score (APS) of APACHE III and patient demographic data can predict hospital death rate, ICU length of stay, and resource use immediately following coronary by-pass surgery. These estimates may compliment assessments based on pre-operative risk factors in order to more precisely evaluate and improve the efficacy and efficiency of cardiovascular surgery.

APACHE↗
PubMed1995

Families' perceptions of their resources for caring for children with developmental disabilities.

Factors related to families' perceptions of internal resources when raising children with developmental disabilities were examined. Families enrolled in a Cash Subsidy Program were surveyed about their resources, use of services, and helpfulness of social supports. Parents saw their basic resources for daily life as adequate. However, they reported that their time, discretionary money, and child-care resources were not adequate for caring for their children. Helpfulness of social supports, the children's characteristics, and income were related to perception of resource adequacy. Findings suggest that support services must be flexible in the types and amounts of services provided.

Adolescent↗
PubMed1995

Arizona Health Information Network: the collaborative administration and management of a statewide computing resource for health information.

The need to access current, relevant health care information transcends the boundaries of the library. Many computer-based tools are now available that provide access to this information where and when it is needed. However, the provision of these tools often requires a substantial commitment of resources in the form of staff expertise, computer hardware and software, and user training. The need to access current information is critical for health care providers and students at all points of care regardless of the institution size or location. Unfortunately, the resources necessary to provide access to information may not be equally available at all sites. The Arizona Health Information Network (AZHIN) joins together librarians and information systems specialists from eleven institutions throughout the state in an effort to share computing resources and expertise in order to improve the quality of health care delivery, education and research. This cooperative effort allows each institution to contribute both financially and in the form of staff expertise, based upon its size and available resources. Although the benefits of this type of cooperation seem obvious, in a competitive environment it is necessary for each member to retain independence. To balance cooperation and independence, a framework has been established to enable individual AZHIN member institutions to administer local access to the shared resources.

Academic Medical Centers↗
PubMed1996

Ganciclovir evaluation in AIDS patients with cytomegalovirus retinitis: a European study of treatment patterns and resource utilization.

OBJECTIVE: To describe the treatment patterns for intravenous ganciclovir induction and maintenance therapy in AIDS patients with cytomegalovirus (CMV) retinitis in five European countries and to investigate the anticipated impact of oral ganciclovir on resource utilization during maintenance. DESIGN: Study was a retrospective analysis based on a prospective randomized clinical trial (AV1034) comparing the efficacy of oral versus intravenous ganciclovir in CMV retinitis maintenance therapy. Resource utilization patterns for ganciclovir induction and maintenance, retinitis progression and management and treatment of adverse events were based on clinical trial data and interviews with local experts involved in treatment of patients with CMV retinitis. RESULTS: Oral ganciclovir maintenance was effective, although associated with a faster time to progression, compared to intravenous ganciclovir. There was considerable variation in the treatment patterns for induction with intravenous ganciclovir in the different countries. Most inductions were achieved with a central intravenous line, also used in subsequent intravenous maintenance therapy, usually performed on an outpatient or day care inpatient basis. Intravenous maintenance therapy was identified as a large resource utilization which would decrease considerably with the introduction of oral ganciclovir. In addition, decreased incidence of adverse side effects with oral ganciclovir would also lead to decreased resource use. CONCLUSIONS: Introduction of oral ganciclovir is expected to lead to significant reduction in resource use and may avoid the need for central line placement. This, and the lower incidence of adverse side effects, normally associated with intravenous ganciclovir, are also expected to lead to improvement in the patient's quality of life.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Racial differences in self-assessed health problems, depressive cognitions, and learned resourcefulness.

The purpose of this study was to investigate differences in self-assessed health problems, depressive cognitions, and learned resourcefulness in functionally independent older adults, including 30 Black and 30 White elders age 65 and over. Data were collected during structured face-to-face interviews. The two groups were similar in age, gender, education, and income. Results revealed that White elders reported more physical health problems than Blacks, but the types of problems were similar. While White elders reported more depressive cognitions, Black elders were significantly more resourceful. Most importantly, a strong association between depressive cognitions and learned resourcefulness was found for both Black and White elders. Findings highlight the importance of developing strategies to teach or reinforce learned resourcefulness in Black and White elders in order to prevent depression and promote mental health. This study recommends further investigation of racial differences in cognitive-behavior strategies constituting learned resourcefulness, using larger and randomly selected samples.

Adaptation, Psychological↗
PubMed1997

[Usefulness of a multidisciplinary gerontological assessment tool in the allocation of social-health resources].

OBJECTIVES: To analyse the level and characteristics of dependency, and the criteria for prioritizing and allocating resources for people requiring long-stay social-health resources, temporary admission or alternative resources. DESIGN: Descriptive cross-sectional study. SETTING: Social-health care programme of the Costa de Ponent health region. PATIENTS AND PARTICIPANTS: 232 patients evaluated by the social-health interdisciplinary mixed committees in the Anoia, L'Hospitalet and Centre-North Baix Llobregat and Fontsanta sectors during the first half of 1996. MEASUREMENTS AND MAIN RESULTS: A triple-assessment instrument (medical, nursing and social) was worked out, with homogeneous weighting between the three. The Barthel, OARS, Performance Status and Folstein's Minimental indexes were used; and the relationship between the scores on each one of them, the final score and the allocation of social-health resources were established. CONCLUSIONS: This instrument enables long-stay admission requests or social-health short-term admission to be classified and prioritized, so improving equality in access to this resource.

Aged↗
PubMedDate not supplied

Helping families mobilize their personal resources.

With changes in delivery of and payment for health care, hospital stays may be shorter and children may be going home sooner and sicker. Therefore, more care may be required at home. Even with access to a variety of services and resources in the community, families of medically fragile or chronically ill children can be overwhelmed and stressed. Relief can be provided to some degree if families creatively mobilize their own personal resources. However, for a variety of reasons, families may find it difficult to do this. While nurses and other health care professionals are accustomed to helping families find professional services and resources in the community, they can also be invaluable before discharge by assisting families with their personal resources--from giving encouragement and motivation to outlining practical planning steps. Pediatric nurses can use guidelines and a checklist to assist families with mobilizing their resources to ease the transition from hospital to home for the whole family.

Adult↗
PubMed1998

Human resources for health--challenges for the 21st century.

A quality health workforce is critical for the development of health systems and the delivery of health services. Although significant resources have been devoted to this area, imbalances persist in most countries. There is a growing recognition that to address current demographic, epidemiological, technological and socioeconomic changes, approaches to human resources for health development must be more comprehensive. While education and training of health personnel is a crucial element, the areas of policy development, planning and management of human resources must receive appropriate attention. Health sector reform initiatives have not included human resources development as an integral part in their processes, which has led to failures of reforms in some cases. Human resources for health must have a more prominent place on the political agenda of countries. It is apparent that to meet current and future challenges, partnerships between the many actors must be established.

Forecasting↗
PubMed1998

Community programs and resources for persons with multiple sclerosis.

MS is an unpredictable disease. Individuals with MS need to identify community programs and resources that will enhance their ability to cope effectively with the variability of the disease. Health care providers can serve as a primary link to these needed resources. In addition to providing resource information, the health care provider should also educate the person with MS on how to be a self-advocate. This article discusses and shares resources on a variety of questions commonly asked by persons with MS. Topics include general information/research, treatments, self-help groups, exercise, equipment/aids, insurance, employment, emotional aspects, and home care. The resource section contains a general listing of information sources, agencies/organizations, and publishing companies that specialize in issues relating to health and disability.

Community Health Services↗
PubMed1992

Prioritizing Oregon's hospital resources. An example based on variations in discretionary medical utilization.

OBJECTIVE: To provide an alternative to Oregon's treatment-specific approach to rationing, we propose a prioritization based on the local hospital resources invested in discretionary medical admissions. DESIGN: We used 1988 Oregon hospital discharge data to determine age- and sex-adjusted per-capita rates of inpatient days for discretionary medical admissions (for high-variation medical conditions) in each of 33 hospital service areas. Potential ceiling rates were defined based on prevailing utilization rates for discretionary medical admissions in each hospital service area. Savings were calculated under the assumption that resources allocated for inpatient treatment of these conditions in areas that exceed the ceiling rates were reduced accordingly. SETTING: Nonfederal, acute-care hospitals used by Oregon residents. STUDY POPULATION: Oregon residents. MAIN OUTCOME MEASURES: Savings were defined in terms of patient days, hospital beds, hospital charges, and average costs. RESULTS: Among the 16 largest hospital service areas, patient-day rates for discretionary medical admissions ranged from 188 to 335 patient days per thousand. Potential savings from applying different ceiling rates ranged from $0.4 million to $94.7 million per year. If the rate in the state capital (Salem) were used as the ceiling (218 days per thousand), then 238 beds could be closed in 20 hospital service areas, for an estimated cost savings of $47.3 million. CONCLUSIONS: Hospital resources invested in discretionary admissions in high-rate areas represent an important potential source of funds for reallocation to meet other defined health care needs. Setting limits based on units of health care supply (eg, beds, capital equipment, and physicians) should be considered as an option for resource reallocation within health care.

Bed Occupancy↗
PubMed1986

Ethics and resource allocation: an economist's view.

This paper debates some of the issues involved in attempting to apply economic analysis to the health care sector when medical ethics plays such an important part in determining the allocation of resources in that sector. Two distinct ethical positions are highlighted as being fundamental to the understanding of resource allocation in this sector -- deontological and utilitarian theories of ethics. It is argued that medical ethics are often narrowly conceived in that there is a tendency for the individual, rather than society at large, to form the focal point of the production of the service "health care'. Thus medical ethics have been dominated by individualistic ethical coded which do not fully consider questions relating to resource allocation at a social level. It is further argued that the structure of the health care sector augments these "individualistic' ethics. It is also suggested that different actors in the health care sector address questions of resource allocation with respect to different time periods, and that this serves to further enhance the influence of "individualistic' ethical codes in this sector.

Cost-Benefit Analysis↗
PubMed2003

Achieving a paradigm shift in environmental and living resources management in the Gulf of Guinea: the large marine ecosystem approach.

The Gulf of Guinea is situated in the narrow protrusion of eastern Equatorial Atlantic between latitudes 2 degrees S and 5 degrees N and longitudes 8 degrees W to 12 degrees E, spanning a coastline length of approximately 130 nautical miles. The dominant feature of this shallow ocean off the coast of countries in Western Africa is the Guinea Current. The distinctive bathymetry, hydrography, productivity and trophodynamics of this shallow ocean qualify it as a large marine ecosystem (LME) and is indeed recognized as the number 28 of the 64 delineated LMEs globally. This area is one of the world's productive marine areas that is rich in fishery resources, oil and gas reserves, precious minerals and an important global reservoir of marine biological diversity. Unfortunately, pollution from residential and industrial sources has affected the waters of the Gulf of Guinea resulting in habitat degradation, loss of biological diversity and productivity, and degenerating human health. In reversing this trend of marine environmental degradation, the countries of the region adopted an integrated and holistic approach using the LME concept to sustainably manage the environmental and living resources of the region. The concept is predicated on the fact that marine environmental pollution and living resources respect no political or geographical boundaries and so require a holistic and regional approach for its management. The Gulf of Guinea countries through the Global Environment facility funded regional/communal project on water pollution control and biodiversity conservation achieved a paradigm shift in living resources and environmental management in the region using the LME concept.

Atlantic Ocean↗
PubMed1991

Resources for infertility treatment.

Infertility is common, a serious medical problem in both advanced and underdeveloped countries. At present, medical resources are often used very haphazardly and frequently extravagantly to combat fertility problems. Whilst it seems very unlikely that society will be able to prevent infertility effectively, there is no doubt that the resources available could be better organized for greater benefit. There is evidence of poor co-ordination of services, of inadequate financial planning by health managers, and squandering of limited resources by professionals. Better organization of in vitro fertilization (IVF), with the promotion of larger regional services, would be an effective use of finances. IVF is too often only available to the wealthy and the selection of patients for treatment is frequently arbitrary; many fertility treatments are of unproved value and are wasteful. It is argued, for example, that many patients receiving gamete intrafallopian transfer (GIFT) for so-called 'unexplained infertility' would be better treated by other, less expensive, methods which are often more effective. Many useful treatments, such as tubal surgery, are being disregarded or misused and there is need for better education of specialists who treat infertile patients. Better primary care of infertile patients should include non-medical counselling, and investigation and firm diagnosis before treatment is commenced. The heavy accent on high technology in the treatment of infertility is often misplaced, and we need to strike a careful balance if resources are to be properly allocated.

Adaptation, Psychological↗
PubMed1988

Selecting patients when resources are limited: a study of US medical directors of kidney dialysis and transplantation facilities.

This study reports and discusses responses of 453 medical directors of renal dialysis and transplantation facilities to detailed patient selection questionnaires. The questionnaires examine selection criteria being used today as well as those which would be employed were resources to remain or become scarce relative to need. Selection criteria examined (and the number of directors supporting them when resources are limited) are: qualitative prognosis, psychological stability, likelihood of medical benefit, quantitative prognosis, medical benefit (virtually all); willingness, age (very large majority); unique moral duties, disproportionate resources, environment, progress of science, social value (majority); ability to pay, random selection, constituency (very large minority); sex (virtually none). Qualitative prognosis, quantitative prognosis, medical benefit, ability to pay, and especially age are the criteria employed today whose influence would increase if resources are further limited. Some of the ethical implications of various criteria are discussed.

Eligibility Determination↗
PubMed2003

Integer/linear mathematical programming models: a tool for allocating healthcare resources.

In today's environment, the demand for efficient healthcare resource allocation is increasing. As new technologies become available, allocation decisions become more complex and tools to assist decision makers in determining efficient allocations of healthcare resources are encouraged. Mathematical programs have multiple properties that are desirable for healthcare decision makers such as the simultaneous consideration of multiple constraints and a built-in sensitivity analysis. These models have been well researched and are considered invaluable in other industries. Mathematical programming has also become increasingly visible in facilitating the allocation of healthcare resources in the health services research sector. However, the use of mathematical programming tools has been limited in economic evaluations of new technologies. Budget allocations, such as formulary, drug development, and pricing decisions may benefit greatly from the use of mathematical programs. As an increasing number of expensive new technologies become available and pressure grows to contain healthcare costs, these tools may help guide a more efficient allocation of resources for technologies under budgetary and other constraints.

Decision Making↗
PubMed1995

Population and resources in Mauritius.

"The island of Mauritius was facing a crisis by the 1950s as the relationship between its population and resources became unbalanced....A two-pronged strategy was set in place to change the relationship between population and resources. Firstly, an aggressive family-planning policy was established, reducing population growth. Secondly, the economy was diversified with tourism, financial services and, especially, manufacturing in the Mauritius Export Processing Zone, creating extra finance and resources. The changes have not been cost-free but Mauritius ends the century, not as a classic case of overpopulation, but more [as] a model micro-state that has overcome many population and resource problems, largely through its own efforts."

Africa↗