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At least 829 records · Page 46Linked to original sources
PubMed1999

Benchmark analysis of diabetic patients with neuropathic (Charcot) foot deformity.

During a 10-year period, 237 patients (129 women, 108 men) with a diagnosis of neuropathic (Charcot) arthropathy of the foot and ankle were treated in a tertiary care university hospital medical center. During this period, 115 of the patients (48.5%) were treated nonoperatively as outpatients with local skin and nail care, accommodative shoe wear, and custom foot orthoses. A total of 120 (50.6%) underwent 143 operations. Surgery included 21 major limb amputations, 29 ankle fusions, 26 hindfoot fusions, 23 exostectomies, and 23 debridements for osteomyelitis. It is widely accepted that patients with diabetes are at risk for developing foot ulcers, which can lead to lower extremity amputation. Within the population of diabetic patients, it is widely accepted that patients with neuropathic (Charcot) arthropathy of the foot and ankle have one of the highest likelihoods of having to undergo lower extremity amputation. The current emphasis in care of the foot of a diabetic patient involves a multidisciplinary team approach combining patient education, skin and nail care, and accommodative shoe wear. As data from prophylactic programs become available, resource allocation and cost of care can be compared with this benchmark baseline. This benchmark analysis can be used by those who are responsible for allocating resources and projecting healthcare costs for this "high utilization"/high risk patient population.

Ankle Joint↗
PubMed2006

Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh.

BACKGROUND: Household food insecurity and under-nutrition remain critically important in developing countries struggling to emerge from the scourge of poverty, where historically, improvements in economic conditions have benefited only certain privileged groups, causing growing inequality in health and healthcare among the population. METHODS: Utilizing information from 5,977 children aged 0-59 months included in the 2004 Bangladesh Demographic and Health Survey , this study examined the relationship between household wealth inequality and chronic childhood under-nutrition. A child is defined as being chronically undernourished or whose growth rate is adversely stunted, if his or her z-score of height-for-age is more than two standard deviations below the median of international reference. Household wealth status is measured by an established index based on household ownership of durable assets. This study utilized multivariate logistic regressions to estimate the effect of household wealth status on adverse childhood growth rate. RESULTS: The results indicate that children in the poorest 20% of households are more than three time as likely to suffer from adverse growth rate stunting as children from the wealthiest 20% of households (OR=3.6; 95% CI: 3.0, 4.3). The effect of household wealth status remain significantly large when the analysis was adjusted for a child's multiple birth status, age, gender, antenatal care, delivery assistance, birth order, and duration that the child was breastfed; mother's age at childbirth, nutritional status, education; household access to safe drinking water, arsenic in drinking water, access to a hygienic toilet facility, cooking fuel cleanliness, residence, and geographic location (OR=2.4; 95% CI: 1.8, 3.2). CONCLUSION: This study concludes that household wealth inequality is strongly associated with childhood adverse growth rate stunting. Reducing poverty and making services more available and accessible to the poor are essential to improving overall childhood health and nutritional status in Bangladesh.

Journal Article↗
PubMed2004

Developing programs for homeless veterans: understanding driving forces in implementation.

Between 1992 and 2003, services for homeless veterans at the Veterans Affairs Greater Los Angeles Healthcare System went from inappropriate utilization of hospital medical and psychiatric beds, to a continuum of residential treatment, transitional housing, and employment programs through arrangements with private agencies. The authors use elements of Hasenfeld and Brock's Political Economy Model (1991) to explain this transformation in service delivery that was spearheaded by a VA social work leadership team. It is argued that three driving forces crucial to program implementation were present: technological certainty, economic stability, and concentration of power. Evidence of the implementation's impact includes creation of new homeless program beds, a reduction in use of medical/psychiatric beds, and a large number of formerly homeless veterans with housing and employment at program discharge. Study limitations and implications for future studies are discussed.

Employment↗
PubMed2005

Technical issues in DNA microarray production and utilization: impact on clinical research.

The adoption and utilization of genomic technologies in healthcare requires that many issues surrounding the integrity of these assay platforms, as well as their overall impact on human health, be definitive. Many concerns common to DNA microarray production must be addressed to exploit the high-content screening capabilities of this assay platform for both genotyping and gene expression profiling in the clinic. Equally important to the success of genomic technology in healthcare is the development of a supporting information system that offers impact at both the personal and population level, and facilitates the adoption, use and, ultimately, impact of genomic information in therapeutic decision support.

Base Sequence↗
PubMed2004

The generation gap: differences between children and adults pertinent to economic evaluations of health interventions.

Differences between children and adults have both technical and ethical implications for the design, interpretation and employment of economic analyses of health-related programmes. Even though policy makers increasingly turn to economic analyses to inform decisions about resource allocation, pertinent child-adult differences have received fragmented discussion in leading methodological references. Key areas warranting attention include: the ways in which a child's distinctive biology modifies the cost and effectiveness of healthcare interventions; challenges in assessing utilities for infants and young children given their limited but developing cognitive capacity; how a child's age, dependency and disability affect the selection of the appropriate time horizon and scope of the analysis; whether a child's non-wage earning productivity should be incorporated into analyses, and if so, what metric to use; what principles of equity policy makers should employ in using economic evaluations to choose between child- and adult-focused interventions; and whether special protective measures should be introduced to secure the rights and interests of children who cannot advocate for themselves.

Adult↗
PubMed1995

HMOs move east.

California HMOs, experts in squeezing costs out of the healthcare system by slashing hospital utilization and placing more physicians at risk, are looking for new lands to conquer. Leading the trend are four big HMOs that have been on an expansion binge east of the Sierras in the past several years. Foundation Health Corp., FHP International Corp., PacifiCare Health Systems and Health Systems International have moved aggressively beyond California's borders, adding hundreds of thousands of new enrollees.

California↗
PubMed1997

Improving financial and patient outcomes: the future of demand management.

Demand management has evolved from early managed care models that sought to curtail rising costs through demand-side utilization controls. The first generation of demand management relied heavily on financial incentives for consumers and physicians to demand fewer and less costly resources. The second generation of demand management complemented financial incentives with clinically focused strategies. Often, these strategies were implemented directly by the payer on through a primary care physician gatekeeper. The current and coming generation of demand management activities emphasizes informed consumer choice and active participation in preventative health care, resource utilization decisions, and customization of healthcare services. This personal health management aligns financial incentives, clinical care protocols, and consumer decision-support systems to balance outcomes and resource consumption.

Cost Savings↗
PubMed1989

Mooring in safe harbors. Proposed rules set out what's legal, what's not under Medicare fraud and abuse laws.

The 1977 Fraud and Abuse Amendments, which prohibit business relationships that increase Medicare utilization, have created uncertainty among healthcare providers as to which commercial arrangements are legal and which are not. In response to this uncertainty, Congress enacted the Medicare and Medicaid Patient and Program Protection Act of 1987, which required the Department of Health and Human Services to develop regulations that would specify allowable practices. The regulations proposed Jan. 23, 1989, specify "safe harbors" from criminal and civil penalties in the following areas: sales of physician practices, rental agreements, investments by providers, and personal services and management contracts. In addition, the Fraud and Abuse Amendments exempted referrals arising out of a bona fide employment relationship, properly disclosed discounts, and group purchasing arrangements. The proposed regulations attempt to clarify these exemptions. Unfortunately, the proposals do little to calm a healthcare industry that is jumpy about which transactions are permitted and which are not. This is partly because the Internal Revenue Service, Health and Human Services, and the Department of Justice often issue conflicting pronouncements regarding prohibited business transactions by tax-exempt providers.

Contract Services↗
PubMed2000

iMPACT3: online tools for development of web sites for the study of Patients' preferences and utilities

Preferences for health outcomes, often called utilities, are numeric measurements of the patients' opinions about overall quality of life with a disease or a health condition. These measurements are used in economic studies (cost effectiveness analysis) as weights for life years (so called Quality adjusted life years or QALYs), in development of guidelines for clinical care (again as quality weights for life years), and to help identify the best treatment alternative for individual patients through application of decision analysis. iMPACT3 (Internet Multimedia Preference Assessor Construction Tool) is a free publicly accessible web site that helps researchers design experimental protocols for measurement of utilities. When the researcher is finished with his or her design, iMPACT3 generates a set of HTML files that use Javascript to implement the protocol. iMPACT3 then downloads those to the researcher's computer, where they can be used in a stand alone fashion to collect data from patients in a clinic or published on the web. We describe and discuss computer approaches for measurement of utilities and their applications in healthcare. We then discuss the design of iMPACT3 and approaches for automatic generation of web sites for data collection in clinical studies.

Journal Article↗
PubMed2001

Gallbladder pathologies and cholelithiasis.

OBJECTIVE: Cholecystectomy, mostly due to cholelithiasis is one of the most common surgical procedures utilizing a significant amount of healthcare resources. As there are a huge number of cases, for example approximately 300 cases per year in our region, outlines this commonly encountered lesion should be recorded. Also, in an attempt to delineate the outline of the pattern, age and sex distribution of gallbladder diseases in the whole Kingdom, a comparative analysis is also included in this study with 7 other studies published from different parts of the Kingdom. METHODS: Our study consisted of 740 consecutive gallbladder cholecyctectomies mostly for cholelithiasis received in a time frame of 3.5 years (for example between January 1997 through to May 2000) by the Department of Histopathology retrieved from the records of the laboratory. The outline of main gallbladder pathologies was tabulated. The number of gallbladders received with stones was also calculated. Age and sex distribution for gallbladder pathology and gallstones was also tabulated. RESULTS: There were 131 males (18%) and 609 (82%) females, with a female ratio male 4.6:1. Benign lesions comprised 99% (mean age 36), mostly chronic cholecyctitis (97%) and acute cholecystitis which constituted 15 cases only (2%), malignant lesions comprised only 7 cases for example 1% of all lesions (mean age 65). CONCLUSION: Gallbladder pathologies are very common and similar results have been obtained from other studies by comparative analysis. The mean cholecystectomy rates in the Kingdom totalled approximately 10%, mean age for all cholecystectomy diseases in both sexes equalled 37.05. The mean age for males was 42.26, females 37.25 and their ratio was 44.5:1.

Adult↗
PubMed2006

View from the top: CEO perspectives on executive development and succession planning practices in healthcare organizations.

Many healthcare professionals question whether the industry's hospitals and multi-site systems are implementing the necessary executive development and succession planning systems to ensure that high potential managers are prepared and aptly selected to assume key executive roles. Survey data, case studies, and cross-industry comparisons suggest that healthcare organizations may face a leadership crisis as the current generation of chief executive officers (CEOs) nears retirement while traditional means of developing the leadership pipeline, including middle-management positions and graduate programs requiring formal residencies, continue to dissipate. Given the daunting challenges that accompany the healthcare industry's quest to identify, develop, and retain leadership talent, this article provides best practice findings from a qualitative study of 13 healthcare organizations with a record of exemplary executive development and succession planning practices. CEOs from six single-site hospitals, six healthcare systems, and one medical group were interviewed to identify industry best practices so that healthcare practitioners and educators may utilize the findings to enhance the industry's leadership capacity.

Administrative Personnel↗
PubMed1995

Role of clinical practice guidelines and clinical profiling in facilitating optimal laboratory use.

Many studies have demonstrated the potential benefits of clinical practice guidelines in improving clinical practice. Moreover, several different kinds of clinical profiles have been developed to address issues related to quality, utilization, and outcomes of specific healthcare practices. With this expanded use of clinical practice guidelines and clinical profiles, clinical laboratory specialists have an opportunity to play an influential leadership role.

Chemistry, Clinical↗
PubMed1995

On-line urea monitoring: a further step towards adequate dialysis prescription and delivery.

The aim of this study is to present a clinical experience carried out with a new device designed to measure on-line Urea Nitrogen concentration in the effluent dialysate. The Biostat 1000 Urea Monitor (Baxter Healthcare, Dirfield, Ill, USA) was utilized in the present study. The monitor is based on the principle that multiple urea measurements in the dialysate effluent from the dialyzer, permit to built a double exponential regression leading to the urea kinetic parameters of the dialysis session. Data obtained with the Urea Monitor were, in the present study, compared with those obtained by direct measurements carried out in blood and dialysate and by the collection of the whole amount of spent dialysate. The monitor provided an accurate value of predialysis BUN without any blood drawing. Urea kinetics were established from multiple dialysate measurements and no blood drawing was necessary. The double pool kinetics were taken into account and Kt/V, PCR and SRI% obtained were comparable to those obtained from direct measurement. Since a projected value of Kt/V can be obtained, the monitor could represent a potential source of information to detect possible filter and machine dysfunction, as well as high rate of recirculation.

Adult↗
PubMed2005

[Health services utilization in areas covered by the family health program (Qualis) in Sao Paulo City, Brazil].

OBJECTIVE: The Family Health Program (FHP) is a strategy for reorganizing the healthcare attendance system within the Brazilian National Health System. The objective of the study was to assess whether there had been changes in the utilization profile of the healthcare services following implementation of the program, and to identify factors associated with any changes observed. METHODS: Data on service utilization and demand for attendance were analyzed by means of two cluster-based population samples, representing areas covered (n=1865) and not covered (n=2036) by the FHP, in two districts of the municipality of Sao Paulo. The data formed part of a population survey carried out in 2001. Statistical methods for cluster analysis were used. RESULTS: In the area covered by the FHP, no statistically different prevalence ratios (PR) according to schooling and income levels were observed for service utilization. In the area not covered by the FHP, service utilization was positively associated with greater schooling and income. Among individuals with illnesses, the demand for attendance in the area covered by the FHP was higher (higher PR) among those with severe physical limitations. In the area not covered, the PR was higher among those with greater schooling and lower among those who were inactive (unemployed or retired). CONCLUSIONS: In the areas studied, for the population covered by the FHP, income and schooling levels did not constitute factors that significantly differentiated the utilization profile of the healthcare services and the demand for attendance. This indicates that the program may be contributing towards greater equity under these conditions.

Adolescent↗
PubMedDate not supplied

A survey of exercise testing: methods, utilization, interpretation, and safety in the VAHCS.

BACKGROUND: Healthcare organizations are being graded in terms of their adherence to practice guidelines. The authors sought information on practice patterns of exercise testing within the Veterans Affairs Health Care System (VAHCS) to determine how well current practice patterns adhere to current guidelines. In addition, we sought to update past surveys to determine methods, indications, utilization of alternative diagnostic modalities, criteria for interpretation, safety, and physician supervision of exercise testing within the VAHCS. METHODS: Questionnaires were sent to 72 of the largest Veterans Affairs Medical Centers with cardiology divisions. The centers were queried regarding volume and type of exercise testing (standard, nuclear, and echocardiographic), indications, safety, protocols used, and criteria for interpretation. RESULTS: Seventy-one questionnaires were returned, comprising a total of 75,828 exercise tests performed within the last year. Virtually all indications for exercise testing fit the American Heart Association/American College of Cardiology (AHA/ACC) guidelines Class I criteria; 46% of patients were tested for the evaluation of chest pain; 14% were tested to evaluate patients at high risk for coronary artery disease; 10% were preoperative evaluations; and 8% were post-myocardial infarction evaluations. The most commonly used diagnostic test was the standard exercise electrocardiogram; a patient was five times more likely to undergo a standard exercise electrocardiogram or nuclear exercise test than an exercise or pharmacologic echocardiogram. The largest proportion of centers (49%) used 1.0-mm horizontal or downsloping ST depression as a criterion for an abnormal test, although 22% considered 1.5-mm upsloping ST depression to be abnormal, and 25% relied on a treadmill score. Seventy-eight percent of respondents used the treadmill, and of these, 82% used the Bruce or modified Bruce protocol. Four major cardiac events were reported (three myocardial infarctions, one sustained ventricular tachycardia) representing an event rate of 1.2/10,000. A physician was present during 73% of all standard exercise tests; 21% of respondents reported that a physician was required to be present "only for high-risk patients." CONCLUSION: Indications for exercise testing are in close agreement with the AHA/ACC guidelines; thus, the test continues to have an important role in diagnosis and prognosis among patients with or suspected of having coronary artery disease. The exercise test is an extremely safe procedure, with an event rate similar to other recent surveys. However, a great deal of variation exists in terms of criteria for abnormal results and whether physician presence is required during exercise testing.

Coronary Disease↗
PubMed2002

Managing healthcare costs within an integrated framework.

Laupacis, Anderson and O'Brien's comprehensive diagnosis of the illness affecting the Canadian healthcare system is very insightful. In addition, their call for improving the quality of drug evidence and outcomes is a laudable goal. However, their prognosis of the negative impact on healthcare due to escalating drug costs appears to be rather pessimistic, as they fail to view drugs within an integrated framework. In part, their prescription for the perceived malady is rather impractical. Their recommendation for mandatory head-to-head randomized studies, as a prerequisite for achieving new drug listing in benefit formularies, suffers from many drawbacks. Such studies would be highly time-consuming, extremely costly, and given the fact that the choice of a drug comparator is a "moving target," the end result may not achieve the original intent. Growing anxieties about the rising healthcare costs in Canada, now forecast to reach C$100 billion in 2002, have led to implementation ofa variety of reforms aimed at cost-cutting. Shifts in drug utilization, demographics and prescribing have contributed to the authors' understandable concern about the rapid rise in drug plan expenditure, which has undeniably outpaced the increases of other healthcare components. However, drug plan costs represent only 7.7% of total provincial/territorial healthcare expenditures. Innovative medicines have played a significant role in reducing the burden of illness and overall healthcare costs. Drugs prevent, treat and cure disease, improve quality of life, control pain/suffering and save lives. Despite their great value, spending on drugs has received particular scrutiny from policy-makers, and pharmaceuticals have become the primary cost-containment target. The authors' goal-oriented concept of creating a clinical milieu that encourages cost-effective prescribing via "optimum" drug use is very attractive. One such approach is Disease Management, which relies on evidence-based, outcome-oriented performance indicators. It is highly regarded for promoting effective treatment options, improving patient care and optimizing healthcare resource utilization--hence deserving serious consideration for reducing overall costs while achieving improved outcomes.

Canada↗
PubMedDate not supplied

Wealth from Health: an incentive program for disease and population management: a 12-year project.

The future of healthcare is linked with its ability to face the challenges of consumerism. Disease and population management will represent the dominant style of healthcare delivery in the future. This article describes the Wealth from Health programs which utilize current and future technologies to help the healthcare system become a leader in healthcare delivery and to assist many communities at an affordable cost.

Asthma↗