Supplement editorial: alzheimer disease.
Explore the source record for details and available documents.
Aged↗
SEARCH · Search PubMed
Results for “Resource”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Resource use and service costs for ventilator-dependent children and young people in the UK.
This paper describes the resource use and costs involved in supporting ventilator-dependent children and young people at home compared with those in hospital. Accommodation arrangements, patterns of service and resource use in the year prior to interview were recorded for 35 index cases aged 1-18 years using a piloted variant of the Client Services Receipt Inventory. Costs to the National Health Service (NHS), social services (excluding local authority housing costs), education (excluding basic statutory education costs), and voluntary and independent sectors were included. For each of the resources and supports used, a unit cost was calculated at 2002 prices, which was a close approximation to the long-run marginal opportunity cost. Of the 35 cases, 24 lived at home, seven were in hospital and four had transferred from hospital to home during the previous 12 months. Twelve used ventilation 24-h per day. The children and young people made intensive use of NHS services and resources. In total, the 35 cases cost just over pound 6.2 million to support during the year prior to interview; 92% of the costs were borne by the NHS. It was mostly, but not always, cheaper for children to live at home. A care package including qualified nurses and 24-h care (mean=pound 239,855 per year) was more expensive than a children's ward (mean=pound 155,158 per year), but less expensive than a long-term ventilation unit (mean=pound 301,888 per year) or an intensive care unit (mean=pound 630,388 per year), where most cases live whilst awaiting discharge. Support costs for children with complex ventilator dependency were seven times higher than those with simple ventilator dependency. These estimates provide commissioners and managers with good-quality data to inform the implementation of recently published national guidance on care for these children and young people.
Adolescent↗
Resource utilization by injured automobile occupants and pedestrians.
BACKGROUND: This study was designed to test the hypothesis that the hospital resources utilized in treating pedestrian trauma would be significantly greater than that for automobile occupants. This was based on previous studies that showed that the demographic features and patterns of injury sustained by the pedestrian population were significantly different from that of automobile occupants. METHODS: A hospital-based study was designed utilizing retrospective analysis of a prospective trauma database. All primary retrievals of pedestrians (n=547) and automobile occupants (n=597) involved in accidents in Central Sydney from mid-1990 to mid-1995 were included. The length of hospital stay, use of the intensive care unit (ICU) and visits to the operating theatre (Standard Resource Cost) were compared. RESULTS: The age and injury severity scores were significantly higher for the pedestrian group. The length of stay (days) for the pedestrians (mean, 12 SD 14; median, 7 interquartile range (IQR) 13), was significantly higher (P < 0.0001 ) than that for the automobile occupants (mean, 7 SD 11; median, 2 IQR 6). The ICU utilization (days) for the pedestrians (mean, 1.3 SD 4.0; median, 0) was significantly higher (P < 0.0001) than that of the automobile occupants (mean, 0.6 SD 2.9; median, 0). The average operating theatre utilization per pedestrian (0.65 visits) exceeded that of automobile occupants (0.43) by 50% (P < 0.0001). CONCLUSIONS: The study confirms that the acute care of pedestrian injury utilizes more hospital resources than that of automobile occupants. Resources should be allocated to meet this need both in terms of hospital reimbursement and overall directives in public health policy.
Accidents, Traffic↗
The resource dependence of a county nursing department: efforts to thrive in the 1980s.
This case study documents analysis and planning in a contemporary public health nursing organization using resource dependence organizational theory. Several internal and external factors affect the organization and its relationships with its resources. We attempted to use knowledge of the environment-organization relationship in several ways. Three examples from inside and outside the county system demonstrate opportunities for nursing to decrease the organization's traditional resource dependence and expand its base of funding and influence. Application of this theory can assist other organizations to adapt and survive in this era of diminishing health care resources.
Health Resources↗
Prediction of resource utilization and case cost for acute nonvariceal upper gastrointestinal hemorrhage at a Canadian community hospital.
OBJECTIVE: Upper gastrointestinal hemorrhage (UGIH) is common, and thus imposes a substantial burden on health care resources. We describe resource utilization and cost for management of acute nonvariceal UGIH, and studied their variation among population subgroups. METHODS: Resource utilization and direct medical case costs were extracted for consecutive admissions for nonvariceal UGIH at a large community hospital in southern Ontario through chart review and adaptation of an administrative case cost database. Univariate and multiple regression models were then developed to identify independent demographic predictors of case cost and length of stay. RESULTS: Among 116 eligible admissions the average length of stay and case cost were 4.26 days and Can$2690, respectively (Can$1 = US$0.70). Both cost and length of stay demonstrated significant univariate relationships with age, comorbid illness, prior peptic ulcer disease (PUD), and prior UGIH. Age and prior PUD persisted as independent predictors in multiple regression models. An inverse transformation of total case cost allowed these variables to explain 26% of the total variance. CONCLUSIONS: Resource utilization for management of acute nonvariceal UGIH at a Canadian community hospital varies substantially among population subgroups, but correlates independently with age and prior ulcer history. Careful attention must be paid to practice environments and demographic profiles before economic models of strategies to prevent or treat UGIH are applied to specific subpopulations.
Acute Disease↗
Utilization of health care resources by individuals with inflammatory bowel disease in the United States: a profile of time since diagnosis.
BACKGROUND: There are no cost studies of inflammatory bowel disease (IBD) that describe its impact on resource utilization or treatment costs over long periods of time. Our aim was to determine if there are observable trends in health-care resource utilization by adults with IBD depending on disease duration. METHODS: The 1999 U.S. National Health Interview Survey (n = 30,801; N = 195,398,057) included 256 adult cases with IBD who indicated the number of years since the onset of disease. Cases were grouped according to the "number of years with IBD" to distinguish between recent diagnosis (0-5 yr with IBD), long-standing IBD (6-15 yr with IBD), and very long-standing IBD (16-62 yr). A group of non-IBD controls was established and age and gender were controlled for through logistic regression analysis. Odds ratios were computed for resource use including hospitalization, health provider contact, and prescription medication. Population estimates were computed, while accounting for the complex survey design. RESULTS: When compared with the general population, IBD patients were more likely to visit a specialist and to use prescription medication regardless of disease duration. GP visits were more likely until 15 yr with diagnosed IBD [0-5 yr with IBD: OR = 2.26; 95% CI = (1.21-4.21); 6-15 yr with IBD: OR = 2.73; 95% CI = (1.17-6.37)]. Home care was more likely in the IBD population with long-standing disease [OR = 3.21; 95% CI = (1.22-8.40)]. An emergency room visit [OR = 2.41; 95% CI = (1.49-3.88)] and hospitalization [OR = 2.34; 95% CI = (1.38-3.96)] were more likely in the first 5 yr since diagnosis as was hospitalization and surgical intervention [OR = 2.14; 95% CI = (1.09-4.19)]. CONCLUSION: Specialist physicians are visited by IBD patients, and prescription medications are provided to treat IBD patients throughout their lives. This is a statistically significant trend that is viewed from onset of the disease to up to 62 yr with IBD. Our results also suggest, at least tentatively, that patients within the first 5 yr after the onset of the disease have a stronger tendency than the general population to visit an emergency room, to be hospitalized, and to have been both hospitalized and to have had surgery. If these results were borne out by further studies, then this would indicate that we can measure the greatest proportion of treatment effects on these resources within a relatively short period.
Adolescent↗
Subregional resource allocations in the National Health Service.
The Resource Allocation Working Party in its report Sharing Resources for Health in England proposes a formula for the identification of both regional and district financial targets (Department of Health and Social Security, 1976). In this paper it is argued that the national formula is not a valid instrument for the latter purpose. Furthermore, research into medical needs and outcomes will not be adequate to bring about real changes in resource distribution at local levels unless it is recognised that the health authorities can meet needs in different ways and that a change in resource management from institutional to service budgeting is required.
Catchment Area, Health↗
The ethics of allocation of scarce health care resources: a view from the centre.
Resource allocation is a central part of the decision-making process in any health care system. Resources have always been finite, thus the ethical issues raised are not new. The debate is now more open, and there is greater public awareness of the issues. It is increasingly recognised that it is the technology which determines resources. The ethical issues involved are often conflicting and relate to issues of individual rights and community benefits. One central feature of resource allocation is the basing of decisions on the outcomes of health care and on their subsequent economic evaluation. The knowledge base is therefore of great importance as is the audit of results of clinical treatment. Public involvement is seen as an integral part of this process. For all parts of the process, better methodologies are required.
Biomedical Research↗
Outpatient follow up appointments; are we using the resources effectively?
OBJECTIVE: British Association of Urological Surgeons (BAUS) guidelines and government initiatives have put pressure on the effective use of outpatient resources. Follow up appointments need to be carefully managed to ensure efficient use of available resources. The aim of this study was to audit outpatient follow up service with particular attention to the appropriateness of the appointments made. METHODS: All patients attending a general urology clinic were assessed by a form completed for each individual appointment. The source of the appointment and the time interval was recorded and each follow up appointment was judged to be either appropriate or inappropriate by the person giving the consultation. For those deemed to be inappropriate, justification was sought and the notes independently reviewed by a different clinician to verify this categorisation. RESULTS: Of 164 appointments made, 143 patients attended for follow up. A total of 131 appointments were considered to be appropriate (92%) with only 12 deemed by the consulting clinician to be inappropriate (8%). The commonest cause for an inappropriate appointment was failure to appreciate that follow up had already been arranged for a different date. There was no correlation between the source of the referral and an inappropriate referral. CONCLUSION: This audit suggests an effective use of the outpatient follow up resource with respect to the appropriateness and timing of follow up consultations. Other areas of resource management such as default rates should be investigated in an attempt to improve the efficiency of a service.
Ambulatory Care↗
Resource utilization for acute lower gastrointestinal hemorrhage: the Ontario GI bleed study.
OBJECTIVES: Acute lower gastrointestinal hemorrhage (LGIH) is a common indication for hospitalization. However, there are few published studies of related health care resource utilization. Resource utilization, length of stay (LOS) and direct medical costs were characterized in a cohort of patients admitted for nonmalignant LGIH to centres in Ontario. METHODS: Consecutive admissions for LGIH were identified at four Ontario hospitals. Profiles of resource utilization, LOS and estimates of direct medical costs were compiled through detailed chart review and adaptation of an administrative database. All centres were participants in the Ontario Case Cost Project. Linear regression models of log-transformed data were constructed to identify demographic variables predictive of LOS and case cost. RESULTS: Among 124 patients enrolled (mean age 58.8 years) the average case cost was dollars 4832 (SD dollars 7187) for 7.5 days in hospital (SD 12.0). Diverticular disease was the bleeding source most often identified (34.6%), followed by hemorrhoids (13.7%) and ischemic colitis (9.7%). Older age and comorbid illness, specifically coronary artery disease (CAD), were associated with both increased LOS and higher case cost in univariate regression analyses. Age persisted as the lone independent predictor of LOS in the multivariate model (P<0.05, R2=0.076), and age and CAD were both independent predictors of cost (P<0.05, R2=0.109) in a stepwise multiple linear regression analysis. Neither sex nor nonsteroidal anti-inflammatory drug use predicted LOS or cost. CONCLUSIONS: Admissions for acute LGIH are associated with significant resource utilization, particularly among elderly patients with CAD.
Acute Disease↗
Stroke patients in south Madrid: function and motor recovery, resource utilization, and family support.
BACKGROUND AND PURPOSE: The purpose of the present study was to describe the epidemiology of stroke disability and the use of health resources in South Madrid. METHODS: Among a population of 665 168 residents in South Madrid, patients with an acute stroke of clinical onset during March to July 1996 who were seen at a general hospital or at 1 of 3 primary care centers were evaluated at baseline (n=147) and at 3 months (n=110) and 6 months (n=112) after stroke. We assessed the frequencies of stroke and stroke-related residual disability per population unit, as well as the impairment, disability, secondary complications, use of health resources, and impact on quality of life. RESULTS: In patients > or =60 years old, the incidence of stroke with severe residual disability after 6 months was 75 per 10 000, was higher in men, and increased with age; the proportion of survivors among those examined at baseline was 20%. The use of hospital days per population unit was similar to that of reported European data, but the use of other health care resources was less. Patients frequently used bladder and nasal catheters and presented with shoulder pain. Social activities were infrequent and decreased after stroke. Access to technical aids was limited, and home adaptations were exceptional. The impact of stroke on health-related quality of life among patients and main caregivers was modest. CONCLUSIONS: The study shows that in South Madrid, (1) the use of health resources after stroke is low; (2) patients with stroke register low activities of daily living scores with a comparatively small impact on quality of life; and (3) relative to need, the use of rehabilitation, aids, and home adaptations and services was low.
Accidental Falls↗
The needs and resources assessment interview for severely mentally ill adults.
The authors report an analysis of the reliability and validity of the Needs and Resources Assessment, an interview instrument that measures patients' needs and resources in 13 domains of functioning and rates patients' overall satisfaction with each domain and the importance of each need. Internal consistency of the instrument's four subscales-- needs, resources, satisfaction, and importance--ranged from .66 to .81, and test-retest reliability of the instrument ranged from .71 to .86. The subscales showed significant correlations with independent scales measuring size of the patient's support network, quality of life, and depressive symptoms. The Needs and Resources Assessment may be useful for prioritizing a patient's needs in developing an intervention plan in rehabilitation settings.
Activities of Daily Living↗
Incidence of infections in patients with status epilepticus requiring intensive care and effect on resource utilization.
Data from a six-year period were retrospectively retrieved from medical records and an intensive care unit data management system to study the impact of infections on patients with status epilepticus. Out of 161 admitted patients, 33 had a community-acquired infection and 35 acquired an infection during their hospital stay, 10 while in a ward before admission to the intensive care unit and 25 while in an intensive care unit, giving an infection rate of 42% of all admissions (68 patients). The patients with intensive care unit-acquired infection had three times longer stays in the intensive care unit than those without any infection (P<0.001), and they utilized almost four times more nursing resources than those without infections (P<0.001). Furthermore, they were more often sedated with thiopentone infusion, either alone or in combination with other drugs, than the non-infectious patients (80% vs 20%, P <0.001). Both community- and hospital-acquired infections were related to longer intensive care unit stays (P<0.001). The hospital stay of patients with hospital-acquired infection was threefold compared to that of patients without infection (P<0.001), and these patients utilized almost three times more nursing resources than those without any infection (P<0.001). Patients with infections consumed 65.5% of the intensive care unit nursing resources of status epilepticus patients. In conclusion, the infection rate of status epilepticus patients was high and nosocomial infections were associated with more severe illness, treatment escalation, prolonged hospital stay and enhanced resource utilization.
Adolescent↗
Obese ICU patients: resource utilization and outcomes.
This project described prospectively obese, critically ill patients and the resources critical care nurses used to care for these challenging patients. It also examined the relationship between resources used by nurses and patient outcomes, including complications and length of stay. Forty-three participants were enrolled. Patients with a body mass index (BMI) 40 kg/m2 used the majority of equipment and personnel resources and experienced a prolonged length of stay. The most common equipment used was a specialty bed or mattress; the most common complications were related to the pulmonary system. Initial use of multiple resources may indicate a patient at risk for adverse outcomes. Nurses can use findings to anticipate care needs and develop interventions, such as optimal positioning, to avoid adverse outcomes.
APACHE↗
Social support and social-ecological resources as mediators of lifestyle intervention effects for type 2 diabetes.
A study was conducted to determine if an intervention could change social support and social-ecological resources of post-menopausal women diagnosed with type 2 diabetes, and if those changes mediated the intervention's effects on health behaviors and outcomes. Women (N = 279) were randomly assigned to receive a comprehensive 6-month Mediterranean Lifestyle Program (MLP) or usual care from their physicians (UC). MLP was successful in changing social embeddedness and social-ecological resources, but not a measure of perceived support. Changes in social-ecological resources mediated intervention effects on fat consumption, exercise and glycemic control. The experimental manipulation of mediators and the demonstrated mediation effects support the conclusion that social-ecological resources can contribute to improvements in healthful lifestyles for women with type 2 diabetes.
Diabetes Mellitus, Type 2↗
Muscle weakness is related to utilization of health care resources in COPD patients.
The factors determining utilization of health care resources in patients with chronic obstructive pulmonary disease (COPD) are poorly understood. In order to obtain insight into these factors, we studied the utilization of health care resources in 57 stable COPD patients with a forced expiratory volume in one second (FEV1) of 36 +/- 9% predicted. Patients were divided into two groups: admitted at least twice in the last year (high medical consumption; n = 23) or not admitted in the last year (low medical consumption; n = 34). Other variables related to utilization of health care resources studied were; the number of hospital days; the number of out-patient visits to a pulmonary department in the last year; and the average daily dose (ADD) of corticosteroids taken in the last 6 months. The actual cost of utilization of health care resources, however, was not studied. In addition, pulmonary function, serum electrolytes, blood gas values, 6 min walking distance, respiratory and peripheral muscle force, and appraisal of self-care agency (ASA score) were studied. Pulmonary function, serum electrolytes, blood gas values, ASA score and walking distance were not different between the two groups (e.g. FEV1 36 +/- 8 vs 36 +/- 10% pred). Respiratory muscle forces tended to be lower in the high medical consumption group, this tendency almost reaching statistical significance for maximal expiratory pressure (PE,max) (p = 0.08). Peripheral muscle force, however, was clearly reduced in the high medical consumption group (quadriceps force 63 +/- 20 vs 82 +/- 26% pred; p < 0.05). The number of admissions, the number of hospital days, the number of out-patient visits, and ADD were interrelated and also related to ventilatory and peripheral muscle force (r -0.18 to -0.38). This relationship was statistically significant for PE,max, whilst a similar tendency was present for maximal inspiratory pressure (PI,max). In stepwise multiple regression analysis, only quadriceps force was a significant determinant of utilization of health care services. We conclude that utilization of health care services in patients with chronic obstructive pulmonary disease is related to ventilatory and peripheral muscle force. Whether or not reduced muscle force is simply an expression of disease severity remains to be determined.
Activities of Daily Living↗
A comparison of the resources used in advanced cancer care between two different strong opioids: an analysis of naturalistic practice in the UK.
OBJECTIVE: To assess the resource implications of using strong opioids in patients with advanced cancer in the UK, based on naturalistic practice, in order to develop the evidence base supporting better management. DESIGN AND SETTING: A modelling study performed from the perspective of the UK's National Health Service (NHS). Study participants and interventions: A data set was created from the DIN-link database comprising 986 patients with advanced cancer who were prescribed either 12-hourly sustained release morphine (SR morphine; MST Continuous) ( n = 784) or transdermal fentanyl (Durogesic) (n = 202) as their first strong opioid between 1st January 1998 and 30th September 2000 and died during that period. METHODS: Palliative care-related resource use data were obtained from the DIN-link database. Unit costs at 2000/2001 prices were applied to the resource use values to determine the mean NHS cost of palliative care from the start of treatment until death. RESULTS: Patients initially treated with transdermal fentanyl started their strong opioid regime 8.5 years after diagnosis compared to 6.4 years after diagnosis in those who started SR morphine. This equates to an overall survival period from diagnosis of 8.8 years and 7.4 years respectively. Nevertheless, the total NHS cost of palliative care was similar between treatment groups, ranging from a mean 3087-3462 pounds per patient. Hospitalisation accounted for up to 71% of the total cost and opioids accounted for up to a further 17%. Less than one-third of patients received 4-hourly morphine as part of their initial opioid treatment despite UK guidelines recommending that moderate-to-severe pain should always be managed initially with an immediate-release preparation. Additionally, patients who received transdermal fentanyl as part of their initial treatment received significantly more laxative prescriptions than patients who started with SR morphine. CONCLUSIONS: SR morphine and transdermal fentanyl seem to be used in different situations. The results also confirm previous findings that pain management in cancer patients is often sub-optimal. The low contribution of opioids to the overall costs indicates that this should not be an obstacle to starting this aspect of palliative care earlier in disease progression. This characterisation of the resource implications of using SR morphine and transdermal fentanyl should enable purchasers and providers to optimise the availability of strong opioids for cancer patients on medical, economic and humanitarian grounds.
Administration, Cutaneous↗
Hospital competition, resource allocation and quality of care.
BACKGROUND: A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services. METHODS: To test this hypothesis we studied hospitals in California in 1982 and 1989, comparing resource allocations prior to and following selective contracting, a period during which the focus of competition changed from quality to price. We estimated the relationship between clinical outcomes, measured as risk-adjusted-mortality rates, and resources. RESULTS: In 1989, higher competition was associated with lower clinical expenditures levels compared with 1982. The trend was stronger for non-profit hospitals. Lower clinical resource use was associated with worse risk adjusted mortality outcomes. CONCLUSIONS: This study raises concerns that cost reductions may be associated with increased mortality.
California↗