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Establishing a successful home dialysis program.

The renewed interest in home dialysis therapies makes it pertinent to address the essentials of establishing and running a successful home dialysis program. The success of a home program depends on a clear understanding of the structure of the home program team, the physical plant, educational tool requirements, reimbursement sources and a business plan. A good command of the technical and economic aspects is important, but the primary drivers for the creation and growth of a home dialysis program are the confidence and commitment of the nephrological team.

Direct Service Costs↗

The business of palliative medicine: management metrics for an acute-care inpatient unit.

For any palliative medicine inpatient unit to be economically viable, certain management metrics need to be followed. Palliative medicine can provide both a compassionate and economical service within the current acute inpatient hospital environment. In this article, we will review the administrative and financial factors we have identified that influence the business of acute palliative medicine.

Commerce↗

A perspective on the significance of pandemic influenza.

The identification in February 1976 of a new strain of influenza virus led to the enactment of unprecedented federal legislation to minimize the impact of a potential outbreak of pandemic influenza in the fall and winter of 1976-1977. This legislative program does not, however, represent a commitment of federal resources to deal with the more general, longstanding problem of epidemic influenza. This paper presents a series of estimates of the impact and economic consequences of influenza. By including periods of interpandemic as well as pandemic disease, the estimates offer a broadened perspective of the magnitude of the influenza problem. The estimates show that while the proportions of pandemic influenza can be singularly impressive, the cumulative effects of interpandemic outbreaks are generally of greater consequence. The paper discusses the implications of these estimates and the 1976 legislation for the support and implementation of federal policy on the use of influenza vaccine. While the commitment of resources in support of public policy cannot alone guarantee successful implementation, it must be considered an essential prerequisite for dealing with both interpandemic and pandemic influenza.

Direct Service Costs↗

Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients.

BACKGROUND: Orthopaedic surgeons vary in their management of displaced intracapsular fractures of the hip in healthy older patients. The aim of this investigation was to determine the functional, clinical, and resource consequences of three different types of surgical treatment. METHODS: The study was a multicenter randomized controlled trial. Reduction and fixation was compared with bipolar hemiarthroplasty with cement and total hip replacement with cement. Participating surgeons elected to randomize their patients to be treated with either one of the three types of procedures or with either fixation or bipolar hemiarthroplasty. Functional outcomes were measured with a hip-rating questionnaire and the EuroQol health status measure. Clinical outcomes included mortality and complications. The direct health service costs were compared. Participants were followed up for two years. RESULTS: Two hundred and seven patients were randomized to be treated with one of the three operations, and ninety-one were randomized to be treated with either fixation or bipolar hemiarthroplasty. There were no differences in the mortality rates among the treatment groups. The rate of secondary surgery was highest in the fixation group (39% compared with 5% in the group treated with bipolar hemiarthroplasty and 9% in the group treated with total hip replacement). The fixation group had the worst hip-rating-questionnaire and EuroQol scores at four and twelve months. The total hip replacement group had significantly better functional outcome scores at twenty-four months than the other two groups. Although fixation was initially the least costly procedure, this short-term advantage was eroded by significantly higher costs for subsequent hip-related hospital admissions. CONCLUSIONS: Arthroplasty is more clinically effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip. The long-term results of total hip replacement may be better than those of bipolar hemiarthroplasty.

Aged↗

The current status of hearing care: can we change the status quo?

The members of the profession of audiology often express concern that the services and products that have been developed to provide benefit to the hearing impaired are not sought after or delivered to the majority of those diagnosed with hearing loss. A critical look at the status quo of hearing care delivery in the United States is needed to verify this assumption and to develop strategies to improve the situation. A key concern is the lack of a comprehensive high-quality scientific database upon which to build continuous improvements in the effectiveness of the services and products that are provided to the hearing impaired.

Direct Service Costs↗

The plantar transverse incisional approach for heel spur syndrome. A retrospective study.

The efficacy of the transverse plantar incisional approach for the treatment of recalcitrant heel spur syndrome or plantar fasciitis was investigated by evaluating cases of this procedure performed by the authors from 1991 to 1998. Patient records were reviewed for conservative treatment rendered prior to surgical intervention as well as for the perioperative course of the patient. All patients were asked to complete questionnaires regarding their heel spur syndrome or plantar fasciitis and their opinion of both the conservative and the surgical treatments received.

Adult↗

Direct action.

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Aged↗

Using a microcomputer-based information system to manage and monitor departmental business operations.

This article describes a system which allows administrators, physicians, and other health care managers to do the following: develop pricing strategies for current and future services to be offered, establish human resource needs to meet predetermined service objectives and monitor productivity on a regular basis, investigate the impact of program changes on business profitability prior to the implementation of such changes, and identify operational problems with direction for corrective action.

Computers↗