Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “cost of complexity”

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.

At least 847 records · Page 47Linked to original sources
PubMed2002

Cost-effectiveness of different MRSA screening methods.

We describe a model to examine the cost-effectiveness of various laboratory-screening approaches to detect methicillin-resistant Staphylococcus aureus (MRSA). A critical literature review was used to derive relevant data on the sensitivity (X), specificity (S) and time to result (T) of different tests. Additional cost information was provided by a hospital. Tests were considered in four interactive groups based on a hierarchy of procedures used in laboratories. X, S and Ts of screening tests were then used in formulae to calculate effectiveness for the various tests. The model was developed to explore the effects on MRSA infection acquisition of differing X, S and T for the different tests in detecting MRSA colonized patients admitted to a high-risk unit such as an intensive care unit. It was concluded that taking a sample from the nose alone and inoculating directly on to Ciprofloxacin Baird-Parker agar without broth incubation and confirmation by a Pastorex Staph-Plus test without any methicillin resistance confirmation test was the most cost-effective approach. The complexity of designing this apparently simple scenario is apparent, and we describe many other factors that would need to be considered to refine this model further. However, this and other models should aid the debate and development of more cost-effective screening strategies given the lack of standardization or agreement concerning so many of the variables within the UK and elsewhere.

Cost-Benefit Analysis↗
PubMed2004

Is there a model for demonstrating a beneficial financial impact of initiating a palliative care program by an existing hospice program?

The value of integrating palliative with curative modes of care earlier in the course of disease for people with life threatening illnesses is well recognized. Whereas the now outdated model of waiting for people to be actively dying before initiating palliative care has been clearly discredited on clinical grounds, how a better integration of modes of care can be achieved, financed and sustained is an ongoing challenge for the health care system in general as well as for specific institutions. When the initiative comes from a hospital or academic medical center, which may, for example, begin a palliative care consultation service, financial benefits have been well documented. These palliative care services survive mainly by tracking cost savings that can be realized in a number of ways around a medical center. We tried to pilot 3 simple models of potential cost savings afforded to hospice by initiating a palliative care program. We found that simple models cannot capture this benefit (if it in fact exists). By adding palliative care, hospice, while no doubt improving and streamlining care, is also taking on more complex patients (higher drug costs, shorter length of stay, more outpatient, emergency room and physician visits). Indeed, the hospice was absorbing the losses associated with having the palliative care program. We suggest that an avenue for future exploration is whether partnering between hospitals and hospice programs can defray some of the costs incurred by the palliative care program (that might otherwise be passed on to hospice) in anticipation of cost savings. We end with a series of questions: Are there financial benefits? Can they be modeled and quantified? Is this a dilemma for hospice programs wanting to improve the quality of care but who are not able on their own to finance it?

Delivery of Health Care, Integrated↗
PubMed2005

Enthalpic and entropic effects of salt and polyol osmolytes on site-specific protein-DNA association: the integrase Tn916-DNA complex.

The effect of low molecular-weight compounds on the equilibrium constant K(A) can be used to explore the energetics and molecular mechanism of protein-DNA interactions. Here we use the complex composed of the integrase Tn916 DNA-binding domain and its target DNA duplex to investigate the effects of salt and the nonionic osmolytes glycerol and sorbitol on sequence-specific protein-DNA association. Increasing Na(+) concentration from 0.12 to 0.32 M weakens the binding affinity by a factor of 20. The decrease of affinity is dominated by a large loss of binding enthalpy but only a small loss of binding entropy. This contrasts the concept that the salt-induced weakening of protein-DNA binding is mainly entropic. The large enthalpy loss is discussed in the light of recent views about the nature of the general salt effect. Addition of up to 2.5 M sorbitol and up to 3.3 M glycerol causes a slight increase of the binding affinity. However, both osmolytes lead to a large enthalpy gain and a similarly large entropy loss. This intriguing enthalpy-entropy compensation can be explained in part by an enthalpic chelate effect: The osmolyte tightens the structure of the protein-DNA complex whereby the formation of enthalpically favorable noncovalent interactions is promoted at the entropic cost of a more rigid complex. The results were obtained by isothermal titration calorimetry. They are supported by kinetic experiments showing that the rate of formation of the complex is reduced by salt, but the rate of complex dissociation is not. Glycerol and sorbitol reduce both rates in line with an only small effect on complex stability. This work clarifies the thermodynamic and kinetic response of a novel protein-DNA complex to increased salt and the presence of two common, nonionic osmolytes.

Binding Sites↗
PubMedDate not supplied

Cost analysis: concepts and application.

Public health nurses are increasingly called upon to justify the cost of care or to decide which of two alternative programs is more cost-effective. Cost studies can be complex and difficult to conduct, but an understanding of the basic techniques allows nurses to fully participate in planning, implementing, and evaluating programs that greatly impact the health of the community. This article defines some of the basic terms used in health economics, discusses standard methods of cost analysis, and provides an example of neonatal screening to illustrate methods of describing, measuring, and assigning a value to cost items.

Adrenal Hyperplasia, Congenital↗
PubMed2002

Financial risk sharing with providers in health maintenance organizations, 1999.

The transfer of financial risk from health maintenance organizations (HMOs) to providers is controversial. To provide timely national data on these practices, we conducted a telephone survey in 1999 of a multi-staged probability sample of HMOs in 20 of the nation's 60 largest markets, accounting for 86% of all HMO enrollees nationally. Among those sampled, 82% responded. We found that HMOs' provider networks with physicians, hospitals, skilled nursing homes, and home health agencies are complex and multi-tiered Seventy-six percent of HMOs in our study use contracts for their HMO products that involve global, professional services, or hospital risk capitation to intermediate entities. These arrangements account for between 24.5 million and 27.4 million of the 55.9 million commercial and Medicare HMO enrollees in the 60 largest markets. While capitation arrangements are particularly common in California, they are more common elsewhere than many assume. The complex layering of risk sharing and delegation of care management responsibility raise questions about accountability and administrative costs in managed care. Do complex structures provide a way to involve providers more directly in managed care, or do they diffuse authority and add to administrative costs?

California↗
PubMed1997

Cost-effectiveness of evaluating the new technologies.

The problem of evaluating cost-effectiveness claims is complex and not readily solved. However, such evaluation represents an important direction for technology assessment as resources become more scarce. Neumann et al.'s analysis (1996) represents one solution to the relatively simple problem of pharmacoeconomic studies. In addition, Fryback and Thornbury included a useful method for approaching the cost-effectiveness of all medical technologies. I note that the cost-effectiveness cutoff of $50,000 per quality-adjusted life year is an incremental one, meaning that new technology must be substantially more cost-effective than older technology. This is currently not the case where incremental improvements over previous technology are often quite small. Interested readers are referred to standard tests in the field, including Drummond, Stoddart, and Torrance (1987), Eisenberg (1986), and Sox, Blatt, Higgins, and Marton (1988).

Cost-Benefit Analysis↗
PubMed2004

Similarity-based cooperation and spatial segregation.

We analyze a cooperative game, where the cooperative act is not based on the previous behavior of the coplayer, but on the similarity between the players. This system has been studied in a mean-field description recently [Phys. Rev. E 68, 046129 (2003)]]. Here, the spatial extension to a two-dimensional lattice is studied, where each player interacts with eight players in a Moore neighborhood. The system shows a strong segregation independent of parameters. The introduction of a local conversion mechanism towards tolerance allows for four-state cycles and the emergence of spiral waves in the spatial game. In the case of asymmetric costs of cooperation a rich variety of complex behavior is observed depending on both cooperation costs. Finally, we study the stabilization of a cooperative fixed point of a forecast rule in the symmetric game, which corresponds to cooperation across segregation borders. This fixed point becomes unstable for high cooperation costs, but can be stabilized by a linear feedback mechanism.

Journal Article↗
PubMed1992

Hospitals and their disposal of infectious waste.

A thorny problem facing many hospital managers (often the environmental services manager) today is how to safely handle and dispose of infectious and hazardous waste in a cost-effective fashion. This is a very complex issue, involving myriad regulations, ethical issues, and cost analysis.

Decision Making, Organizational↗
PubMed2026

A hybrid and cost-efficient barcoding strategy for full-length 16S rRNA gene nanopore sequencing of environmental samples.

BACKGROUND: Accurate species-level identification of bacteria in complex environmental samples is essential for applications in biotechnology, ecological monitoring, and clinical diagnostics. Short-read platforms such as Illumina frequently truncate the 16S rRNA gene, limiting taxonomic resolution. In this work, we applied Oxford Nanopore Technology (ONT) long-read sequencing to full-length 16S rRNA amplicon in samples from natural soil amended with lignocellulosic biomass and a simplified microbial community derived from cultures grown on selective and differential carboxymethyl cellulose (CMC)-based substrates, with the aim to evaluate the difference in performance between a real, complex community and a less complex system. To reduce consumable costs, we substituted the standard ONT Barcoding kits with an in-house hybrid barcoding workflow. Specifically, PacBio PCR-based barcoding protocol was used for sample indexing, followed by library preparation using the ONT Ligation Sequencing Kit. This simplified approach retained compatibility with MinION and Flongle flow cells and supported accurate downstream demultiplexing while lowering barcode costs substantially. Additionally, a new bioinformatic workflow tailored to ONT data was implemented. RESULTS: Overall, the hybrid protocol significantly reduced per-sample barcoding costs while preserving high sequencing quality and throughput. The sequencing run yielded over 5 Gb of quality-filtered data (Q-score ≥ 10). Furthermore, the new bioinformatic workflow allowed taxonomic assignment at the species level for 49.38% of annotated taxa, compared to just 4.59% using Illumina NovaSeq sequencing of the V3-V4 region. ONT also recovered 2.3 times more genera and 1.3 times more families. Although 16S rRNA gene sequencing often cannot distinguish between closely related species, particularly within taxonomically complex groups, in this work, full-length reads substantially improved both taxonomic resolution and database matching. CONCLUSIONS: These results show that full-length 16S rRNA sequencing with ONT, paired with a low-cost barcoding strategy, enhanced taxonomic resolution compared to short-read workflows. This approach also offers a scalable and cost-effective option for high-resolution microbiome profiling in research and applied settings.

RNA, Ribosomal, 16S↗
PubMed1988

[Analysis of personnel expenditures in the industrial health care system].

An analysis of the management costs of Industrial Health Care Complexes and its results may be a starting point for the rational resources administration. Of importance is the analysis of wage costs which constitute a reflection of human factor. Human factor, in its turn, is a basis for securing the statutory tasks of Industrial Health Care Complexes. What is necessary is collecting proper information on the means of payment intended for wages for medical personnel. However, this undertaking is accompanied by some difficulties; cost records and financial reports are not efficient for carrying on the wage cost analysis. Therefore, reflections upon the extended evaluation of the costs rate and structure should inspire to provide necessary conditions for performing the routine analyses of financial nature.

Costs and Cost Analysis↗
PubMed2005

[Reimbursement of patients with high costs in a department of otorhinolaryngology of maximum care and refinancing by the German DRG system].

BACKGROUND: With the introduction of a diagnosis related groups (DRG)-system in Germany, the medical analysis of the total costs of caring for a given patient is of significance. The medical identification of cost intensive patients becomes of increasing importance for the financial perspective of a department, because the averaged lump sum system might not break even these treatments. PATIENTS AND METHODS: In the Department of Otorhinolaryngology, University Ulm, a tertiary referral center, the 56 most expensive patients from 3131 inpatients which were treated in 2002 were retrospectively identified and expenses for diagnostic tests, therapy and post-operative complications were analyzed. All patients' related costs, including all costs for personnel, were assigned to a DRG (Version 1.0 G-DRG and G-DRG 2004). RESULTS: The most expensive treatments included extensive tumor surgeries, surgery of the trachea, emergency procedures and reconstructive surgery. Costs increased with complications, prolonged stay in the intensive care unit and simultaneous internal diseases. The cost at our institution for an pharynocutaneous fistula added 3000 Euro. CONCLUSION: The assignment of treatment costs to a DRG is complex. Based on our data extensive surgeries for head and neck malignancies showed a homogeneous cost distribution in the DRG group of G-DRG 2004 which was however inadequately reimbursed. Detailed prospective analyses from multiple centers to identify expensive treatments in the field of otorhinolaryngology are necessary to incorporate modifications into the German DRG-system.

Adult↗
PubMedDate not supplied

Biopsy forceps: disposable or reusable?

Current debate surrounds the cost-effectiveness of disposable and reusable biopsy forceps. Although a complex and arduous task, performing a cost analysis may be necessary to determine which forcep type is more cost-effective. Costs associated with disposable biopsy forceps include their initial cost as well as storage and disposal costs. In addition to initial cost, costs associated with reusable biopsy forceps include reprocessing, maintenance, and repair costs. Estimating the number of times forceps are likely to be reused is also essential to evaluating the cost-effectiveness of reusable biopsy forceps. In general, once a reusable biopsy forcep performs a threshold number of procedures, it becomes more cost-effective than a disposable forcep. While reusable biopsy forceps may be more suitable and cost-effective for larger gastrointestinal endoscopy centers that perform many procedures per day, the convenience of disposable biopsy forceps may make them the more appropriate choice for centers that are smaller and perform only a few procedures each day. Due to significant decreases in the initial cost of disposable biopsy forceps, the cost-effectiveness of reusable biopsy forceps is waning. This article reviews the various issues associated with disposable versus reusable biopsy forceps and provides readers with guidelines for evaluating the appropriateness of both forcep designs in their unique practice setting.

Biopsy↗
PubMed1994

Novel strategies for delivering oxygen: reservoir cannula, demand flow, and transtracheal oxygen administration.

Oxygen-conserving devices can decrease costs because less oxygen is used. However, they may also add costs due to the more complex equipment involved (ie, device and catheter replacement). Oxygen is relatively expensive. To decrease the cost of oxygen therapy, conserving devices must decrease the frequency of home deliveries and/or the number of cylinders used. By promoting mobility and improving adherence to continuous oxygen therapy, oxygen-conserving systems may increase the amount of oxygen used, thus offsetting savings. It is shortsighted to focus only on reducing the costs of oxygen administration. Attention also needs to be directed to patient outcomes such as functional status, use of healthcare services, and quality of life.

Costs and Cost Analysis↗
PubMed2000

The costs of disease.

BACKGROUND: To date there have been no studies identifying and comparing the component costs to treat a large number of diseases for hospitalized inpatients. METHODS: Hospital costs were analyzed for 486 diagnosis-related groups (DRGs) relating to >1.3 million patient discharges from 60 University Hospital members of the University HealthSystems Consortium. For each DRG, length of stay, total cost, and key cost components were analyzed, including accommodation, intensive care, and surgery. RESULTS: In general, total costs of diseases classified as surgical exceeded those classified as medical. Diseases involving organ transplantation typically cost more than other diseases. However, within the studied population, the two DRGs accounting for most total healthcare dollars were percutaneous cardiovascular procedures and management of neonates with immaturity or respiratory failure. CONCLUSIONS: Considering six key cost components, as well as disease complexity and length of stay, the best predictors of total costs for medical conditions were the length of stay and accommodation (housing, meals, nursing services) costs, whereas for surgical conditions, the best predictor of total costs was laboratory costs. This analysis may be used within an individual institution to identify surgical or medical diagnoses with total or component costs at variance with the group mean. A hospital may focus its cost reduction efforts to make decisions to expand, alter, or eliminate particular clinical programs based on comparison of its own total and component costs with those from other hospitals in the database.

Costs and Cost Analysis↗
PubMed2001

Physical, functional and other non-pharmacological interventions for osteoarthritis.

Non-pharmacological interventions are frequently and widely used in the management of patients with osteoarthritis (OA). However, there is little evidence that most of these interventions are efficacious (i.e. that they work under ideal circumstances) owing to the paucity of research studies on these interventions and the fundamental methodological flaws in published studies. Moreover, the clinical effectiveness of non-pharmacological interventions (i.e. their efficacy under the conditions prevailing in clinical practice) is unknown, and cost-analysis of these interventions has not been carried out. If evidence-based management guidelines were to be constructed solely from firm research studies few could be recommended. Established and developing research methodologies and techniques should be employed to construct and conduct research programmes that appropriately evaluate the clinical and cost effectiveness of these complex non-pharmacological healthcare interventions. Establishing clinical effectiveness will ensure that we have practice-based evidence and are administering relevant, effective and optimal healthcare for patients with OA, maximizing the efficient use of healthcare resources.

Costs and Cost Analysis↗
PubMed1976

A low-cost gradient system for high-performance liquid chromatography. Quantitation of complex pharmaceutical raw materials.

A device is described that makes use of an eight-port motor valve to generate step gradients on the low-pressure side of a piston pump with a low dead volume. Such a gradient device with an automatic control unit, which also permits repetition of previous steps, can be built for about half the cost of a gradient system with two pumps. Applications of this gradient unit to the separation of complex mixtures of glycosides and alkaloids are discussed and compared with separations systems using two high-pressure pumps. The gradients that are used on reversed-phase material with solvent mixtures of water and completely miscible organic solvents are suitable for quantitative routine control of pharmaceutical products. The reproducibility of retention data is excellent over several months and, with the use of loop injectors, major components can be determined quantitatively with a reproducibility of better than 2% (relative standard deviation). The step gradient selector valve can also be used as an introduction system for very large sample volumes. Up to 11 can be injected and samples with concentrations of less than 1 ppb can be determined with good reproducibilities.

Chromatography, High Pressure Liquid↗
PubMed1990

Containing costs in public sector hospitals--a strategy for the future. Lessons from a large teaching hospital.

Escalating costs of providing health care are cause for worldwide concern. In South Africa there is increasing concern about expenditure in the public and the private health care sectors. Although public sector expenditure has increased in per capita terms over the past 2 decades, at the micro-level comparison of expenditure over a 14-year period in one major teaching hospital region indicates that, despite increasing complexity and sophistication, real costs have not escalated at a greater rate than the consumer price index, if extraordinary factors are discounted. The development and utilisation of productivity and performance indicators are reviewed and some mechanisms for containing costs in public hospitals are discussed. These include formalized strategic planning and allocation of resources, rationalisation and reorganisation of services, improved productivity and utilisation of scarce health manpower, improved accounting and management information systems, and the development and use of measures of outcome. Concern is expressed regarding excessive quantification of costs and efficiency to the detriment of health care in general.

Cost Control↗
PubMed1996

Team building for continuous quality improvement.

The effective use of teams is becoming critical to problem solving and cost effective management of complex processes. This report suggests a set of critical success factors to guide the nursing manager from team design through team maintenance. These factors should be considered a framework from which to develop an organizationally appropriate approach to the management of teams.

Cost-Benefit Analysis↗