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At least 865 records · Page 48Linked to original sources
PubMed2004

Outcomes of preventive case management among high-risk elderly in three medical groups: a randomized clinical trial.

Preventive case management was implemented by Sharp Healthcare of San Diego with the intention of complementing primary care for geriatric patients enrolled in PacifiCare's Secure Horizons Medicare plan. This article presents patient outcomes after 12 months of participation. The program featured an annual screening questionnaire, appointment monitoring, disease education, and self-management support. It used a prospective design, tracking randomly assigned treatment (n= 1,537) and control patient samples (n = 1,542) for 12 months. Outcomes included physical and mental health status; hospital, ER, and nursing home use; hospital days and expenditures among persons having an inpatient stay; and primary care physician visits. Utilization data were obtained from Sharp Healthcare systems and from screening questionnaires. No statistically significant main effects were found, but persons with three or more independent activity of daily living limitations were about half as likely to have a nursing home admission if they were in case management rather than in the control group.

Aged↗
PubMed2005

IT-based diagnostic instrumentation systems for personalized healthcare services.

This paper describes recent research and development activities on the diagnostic instruments for personalized healthcare services in Seoul National University. Utilizing the state-of-the-art information technologies (IT), various diagnostic medical instruments have been integrated into a personal wearable device and a home telehealthcare system. We developed a wrist-worn integrated health monitoring device (WIHMD) which performs the measurements of non-invasive blood pressure (NIBP), pulse oximetry (SpO2), electrocardiogram (ECG), respiration rate, heart rate, and body surface temperature and the detection of falls to determine the onset of emergency situation. The WIHMD also analyzes the acquired bio-signals and transmits the resultant data to a healthcare service center through a commercial cellular phone. Two different kinds of IT-based blood glucometer have been developed using a cellular phone and PDA(personal digital assistant) as a main unit. A blood glucometer was also integrated within a wrist pressure measurement module which is interfaced with a cellular phone via Telecommunications Technology Association (TTA) standard in order to provide users with easiness in measuring and handling two important health parameters. Non-intrusive bio-signal measurement systems were developed for the ease of home use. One can measure his ECG on a bed while he is sleeping; measure his ECG, body temperature, bodyfat ratio and weight on a toilet seat; measure his ECG on a chair; and estimate the degree of activity by motion analysis using a camera. Another integrated diagnostic system for home telehealthcare services has been developed to include a 12 channels ECG, a pressure meter for NIBP, a blood glucometer, a bodyfat meter and a spirometer. It is an expert system to analyze the measured health data and based on the diagnostic result, the system provides an appropriate medical consultation. The measured data can be either stored on the system or transmitted to the central server through the internet. We have installed the developed systems on a model house for the performance evaluation and confirmed the possibility of the system as an effective tool for the personalized healthcare services.

Accidental Falls↗
PubMed2003

Utilization of health care services by patients with chronic obstructive pulmonary disease.

In order to identify healthcare resource use patterns associated with chronic obstructive pulmonary disease (COPD), resource utilization (RU) data collection was integrated into a randomized, double-blind placebo-controlled study of Viozan (sibenadet HCl). This study enrolled patients with symptomatic, smoking-related COPD, randomized to receive sibenadet or placebo for a 52-week treatment period. A questionnaire establishing typical pre-trial, COPD-related RU was completed by each patient. Subsequent data were collected by means of an Interactive Voice Response System (IVRS) at 30-day intervals (14 time points) during the study and in the follow-up period. The IVRS system facilitated data collection and minimized inconvenience to the patient. Compliance with the requirement to record details of the healthcare services during the year-long study was high. No overall trend for lower RU was associated with sibenadet therapy, which correlates with the lack of sustained clinical effect seen in studies conducted concurrently. These data do, however, provide valuable information on RU associated with COPD and insights into adjustments associated with changes in disease course. Physicians were seen to be the most common source of care for patients with COPD and more of the patients with severe COPD (stage III) than mild (stage I) were seen to utilize the most expensive resources (e.g. inpatient hospital care). For those patients who experienced an exacerbation during the trial (irrespective of treatment group), resource use was increased during the periods when an exacerbation was reported when compared with the periods before or after an exacerbation. The proportion of cases attending the physician doubled and with a trip to the Emergency Room (ER) increased approximately ninefold during the reporting period in which the exacerbation occurred compared with the previous month. This study has shown that use of an IVRS, even in elderly patients, is an effective means of gathering RU data over long periods. The study findings suggest that the advent of effective therapeutic interventions, particularly any with the ability to minimize exacerbations and limit disease progression, could impact on the health care services used and potentially reduce associated costs.

Adrenergic beta-2 Receptor Agonists↗
PubMed2003

Intact skin--an integrity not to be lost.

Maintaining skin integrity can be challenging but it is vital to overall health, particularly in elderly patients. In this population, skin integrity is frequently compromised as a result of under- or over-hydration, which may cause serious complications. Plans of care must include preventive efforts such as the use of barriers and protectants including zinc oxide preparations, petrolatum- and silicone-based ointments and creams, liquid-forming products, adhesive dressings, fluid managers, skin cleansers, and moisturizers. A team approach that includes the patient, caregivers, and healthcare professionals is needed to address patient concerns regarding independence/dependence, utilization of support systems and services, pain, and control of body fluids. The healthcare provider's role in this team should emphasize continuity of care, patient satisfaction, and product selection - all vital to protecting skin integrity.

Bandages↗
PubMed2003

Cost-utility analysis comparing free and pedicled TRAM flap for breast reconstruction.

The purpose of this study was to compare the free TRAM to the unipedicled TRAM flap in postmastectomy reconstruction, using a cost-utility analysis. A decision analytic model was used for this study. Medical costs associated with the two techniques were estimated from the Ontario Ministry of Health Schedule of Benefits (1998). Hospital costs were obtained from St. Joseph's Healthcare, a university hospital in Hamilton, Ontario. Utilities were obtained from 33 "experts" across Canada and then converted into quality-adjusted life-years (QALYs). The probabilities of various health states associated with unipedicled and free TRAM flaps were obtained by reviewing several key articles. The free TRAM flap was more costly than the unipedicled TRAM flap, but it provided more QALYs. The baseline incremental cost-utility ratio (ICUR) was $5,113.73/QALY, favoring adoption of the free TRAM flap. This study showed that the free TRAM flap is a cost-effective procedure for postmastectomy reconstruction in the Canadian healthcare system.

Cost-Benefit Analysis↗
PubMed1996

A new decision model for cost-utility comparisons of chemotherapy in recurrent metastatic breast cancer.

In the absence of comparative clinical and pharmacoeconomic trial data for docetaxel versus paclitaxel as second-line therapy for patients with anthracycline-resistant metastatic breast cancer, a computer-based decision-analysis model was designed to evaluate the comparative utility to patients of these two taxoids. The model used the Markov process to analyse disease states (response, stable disease, progressive disease) and toxicities (acute, cumulative) for each treatment during the period from commencement of up to six 3-weekly cycles of chemotherapy, to death. A cost-utility analysis was carried out using the model, with a probability, a cost and a utility determined for each health state. Response rates were obtained from clinical trial data supplemented by expert clinical opinion. Costs were taken from UK national databases and published sources and the published UK prices of docetaxel and paclitaxel. Utilities for the various health states were established by use of standard gamble and visual analogue methods assessed by 30 oncology nurses in the UK who were acting as proxy patients. The results of the model showed that response rate is the key parameter determining the utility and cost utility of treatments for metastatic breast cancer. Although the total per-patient cost associated with docetaxel was marginally higher than that for paclitaxel (8233 pounds vs 8013 pounds), the higher response rate associated with docetaxel produced an improvement in utility to the patient at an incremental healthcare cost that is acceptable according to available defined limits. Sensitivity analyses revealed that, although the model was sensitive to changes in response rate and drug costs, the cost-utility ratio for docetaxel versus paclitaxel varied within acceptable limits in response to all likely changes in key parameters. In summary, in the base case used in this model, docetaxel produces a substantially larger utility benefit than paclitaxel, at a small additional cost per QALY gained (equivalent to 7 pounds per additional day of perfect health).

Breast Neoplasms↗
PubMed2004

Dual-system utilization affects regional variation in prevention quality indicators: the case of amputations among veterans with diabetes.

OBJECTIVE: To determine the impact of dual-system utilization by veterans on regional variation in lower-extremity amputation rates. STUDY DESIGN: Retrospective longitudinal cohort analysis. PATIENTS AND METHODS: Subjects were veterans with diabetes who used Veterans Health Administration (VHA) care and were dually enrolled in Medicare fee for service in fiscal years (FY) 1997--1999. We evaluated the impact of Centers for Medicare and Medicaid Services (CMS) data on prevalence of baseline foot risk factors, medical comorbidities, and amputations in FY 1997--1998, and ranking of 22 regions using risk-adjusted major and minor amputation rates in FY 1999. RESULTS: The addition of CMS data significantly increased the prevalence of amputations and risk factors for the 218,528 dually eligible veterans (all Pvalues <.001). In FY 1999, we identified 3.1 minor and 4.5 major amputations per 1000 patients (VHA data) versus 5.5 minor and 8.6 major amputations per 1000 patients (VHA/CMS data); the prevalence of any peripheral vascular condition in FY 1997--1998 was 5.7% (VHA) versus 13.0% (VHA/CMS). The impact of including CMS data varied across regions for amputation outcomes, ranging from an additional 34.3% to 150.7%. Using observed-to-expected amputation ratios and 99% confidence intervals, the addition of CMS data changed the outlier status for 8 of 22 regions for both major and minor amputations. CONCLUSION: Risk covariates and amputation outcomes were substantially underestimated using VHA data only. Our findings demonstrate the importance of evaluating dual-system utilization when conducting program evaluations for healthcare systems with a substantial number of dual enrollees.

Aged↗
PubMedDate not supplied

Epoetin alfa and darbepoetin alfa for the treatment of chemotherapy-related anemia in cancer patients in Sweden: comparative analysis of drug utilization, costs, and hematologic response.

A retrospective chart review was performed at 3 Swedish hospitals to evaluate the utilization, outcomes, and cost of using epoetin alfa or darbepoetin alfa to treat cancer patients with chemotherapy-related anemia. Data on dosage, duration of treatment, hematologic response, red blood cell transfusions, and healthcare resource consumption were collected and analyzed at various time points following the initiation of drug therapy. A significantly faster hematologic response and increase in hemoglobin were observed in patients treated with epoetin alfa. Dosages used in clinical practice appeared to be lower than those recommended by Swedish treatment guidelines. There were no significant differences in resource utilization or healthcare costs between the 2 treatment groups. By day 112, the mean treatment cost per patient, in Swedish kronors (SEK), was SEK74,701 (approximately US$9800 or approximately 8300) with epoetin alfa and SEK85,285 (approximately US$11,000 or approximately 9500) with darbepoetin alfa. Drug acquisition and administration accounted for 81% and 67% of the total cost of epoetin alfa and darbepoetin alfa therapy, respectively; the remainder of the total cost was for hospitalization and transfusions.

Adult↗
PubMed1993

Ambulatory care and healthcare reform.

The escalating costs of inpatient care have resulted in the increased utilization of outpatient facilities and home care. As the sites of care proliferate, the system of healthcare delivery must be integrated so that healthcare provision is both cost-effective and safe.

Ambulatory Care↗
PubMedDate not supplied

An early lesson in healthcare reform.

The interdisciplinary approach and focus on the continuum of care applied to the hospital's drug utilization evaluation provide examples of the perspective needed to succeed within the framework of healthcare reform.

Anesthetics↗
PubMed1998

Healthcare international.

How people are treated when they need medical care depends on where in the world they are. In deciding which tools of the medical trade are used to treat disease and when they're used, location is paramount. A country's social policy, healthcare payment systems and cultural factors bear heavily on the utilization of medical technology. The cover story kicks off the magazine's third international healthcare section.

Global Health↗
PubMed1999

Utility of routine postoperative laboratory studies in patients undergoing potentially curative resection for adenocarcinoma of the colon and rectum.

In an effort to lower healthcare costs, this study was undertaken to evaluate the utility of routine postoperative (PO) laboratory studies and determine whether abnormalities alter patient (PT) care. This was a retrospective review of 105 PTs undergoing elective curative resection for colorectal cancer. A serum electrolyte and liver panel and a hematologic panel were drawn in all PTs. OF 8749 total laboratory values obtained, 5894 (67%) were normal. Two of these (0.03%) elicited a therapeutic intervention. Of the 2004 values that were low (23%), 103 (5.1%) elicited a therapeutic response. Of the 851 that were high (10%), 21 (2.5%) elicited a therapeutic response. Of 2089 preoperative laboratory values, 252 (12%) were abnormal, but in only 15 incidences in 9 PTs was any action taken. Three PTs required potassium supplementation and 6 PTs were transfused packed red blood cells before surgery. In the PO period 2603 laboratory values of 6660 obtained (39%) were abnormal. Of these, 735 (28%) were high and 1868 (72%) were low. Twenty of 735 (27%) high values triggered a therapeutic response that most commonly required administration of insulin for elevated serum glucose in 17 of 197 occasions in five diabetic PTs. On three occasions potassium was removed from intravenous fluids. Five of 275 (1.8%) low calcium values were treated in five patients. Potassium was replaced in 17 of 32 occasions in 14 patients where it was low. In this group of PTs, PO serum potassium, hemoglobin levels, and serum glucose in diabetics were the only values important in making therapeutic decisions. If laboratory studies can be streamlined into only those necessary, substantial savings in health care will be seen without sacrificing quality medical care.

Acute Kidney Injury↗
PubMed2002

The liability of medical directors for utilization review decisions.

Managed Care Organizations (MCOs) have turned to numerous cost-containment measures to combat rising healthcare costs. One of the most common is the use of utilization review to ascertain whether a recommended mode of treatment is "medically necessary." When the medical director of an MCO determines that care recommended by a patient's treating physician is not medically necessary and not eligible for coverage (and, as a result, potentially unattainable due to cost), the stage is set for litigation. In such situations, medical directors may become potentially liable for disciplinary action by their state medical licensing board as well as lawsuits for malpractice or negligence. However, plaintiffs wishing to recover damages for improper determinations of this nature or state boards trying to discipline these physicians, face the hurdles of the preemptive force of ERISA, and state doctrines to the effect that corporations (and, derivatively, their medical directors) cannot practice medicine and therefore cannot be liable for malpractice. Conflicting decisions and opinions make it impossible at the present time to have a settled expectation regarding the potential liability of medical directors in this context, although the law appears to be moving toward the treatment of utilization review as medical decisionmaking; therefore, it appears likely that the activities of medical directors increasingly will face state oversight--including the imposition of common law liability in appropriate situations.

Decision Making, Organizational↗
PubMedDate not supplied

Healthcare rationing: issues and implications.

What methods, if any, should be used to practice healthcare rationing? This article looks at healthcare rationing in the United States, identifies ethical issues associated with implementing healthcare rationing, and addresses legal implications. The author utilizes sources from published literature and her own experience. Society must recognize that it does not have the resources available to fulfill all healthcare needs of all its members. Resolution will bring conflict and compromise.

Delivery of Health Care↗
PubMed2005

Healthcare infrastructure, contraceptive use and infant mortality in Uttar Pradesh, India.

This paper analyzes data on approximately 30,000 women from a survey in Uttar Pradesh in 1995 together with the data from surveys of public and private providers of healthcare and family planning services. A framework was developed for analyzing the effects of quality of services on utilization, and for understanding the gradual evolution of the healthcare infrastructure. The empirical results from logistic regressions for use of female sterilization and IUD showed significant effects of quality of services in government and private hospitals, and of socioeconomic variables such as education, caste, and an index of household possessions. Secondly, models for infant mortality of children born in the preceding 3-year period showed significant effects of socioeconomic variables, quality of healthcare services and birth spacing. Lastly, analysis of data at a more aggregated (Primary Sampling Unit) level indicated differential effects of economic development on the quality of services available in the public and private facilities.

Adult↗
PubMed2000

A global inventory of hospitals using powder-free gloves: a search for principled medical leadership.

Scientific experimental and clinical studies have demonstrated that cornstarch on surgical and examination gloves promotes disease by acting as a reactive foreign body in tissue and serving as a vector for latex allergy. Consequently, hospitals have selected an innovative glove selection program utilizing only powder-free gloves. Healthcare workers in emergency medical systems are now wearing powder-free, latex-free gloves to care for the growing number of patients sensitized to latex. A global Internet search has now identified 70 hospitals in the United States and three hospitals in Europe that use only powder-free gloves.

Data Collection↗
PubMed2003

Managing a mixed-registration-type appointment system in outpatient clinics.

INTRODUCTION: Improving outpatient resource utilization significantly enhances the efficiency of healthcare organizations. Substantial number of walk-in patients (average of 72% in our study) to outpatient services is a universal characteristic of Taiwan's healthcare organizations. Consequently, scheduling becomes extremely complicated and important. Selecting the right scheduling alternative, a healthcare organization can markedly improve operating efficiency of outpatient resources. OBJECTIVE: This research applied simulation methodology to analyze several scheduling solutions and found that setting the appropriate arrival time interval for preregistered patients significantly impacts queuing problems in outpatient services. METHOD: Using established simulation models, the effects of various scheduling policies on patients' throughput time and waiting times were revealed. Under alternative model A, the first 20 numbers are reserved for scheduled patients; after that, only even numbers are offered for scheduled ones. Odd numbers after 20 are left for walk-ins. Under alternative model B, front numbers were assigned to scheduled patients successively. The later numbers were left for walk-ins. Alternative model C assigned scheduled patients with even numbers and walk-ins with odd numbers in sequence. Finally, alternative model D was designed to examine the optimal scheduled time interval by conducting the model with different scheduled time intervals such as 3, 5, 7, 9, and 11 min. RESULT: The alternative sequence (alternative model C-assigning even numbers for scheduled patients and odd numbers for walk-in patients, or vice versa) significantly has the least throughput time (average: 34.9 min vs 55.2, 56.2, and 46.2 min) and waiting times (average: 14.7 min vs 34.9, 35.8, and 25.8 min) for walk-in patients compared with other registration strategies. Scheduling the appointments with flexible time interval (alternative model D) has the least throughput time (average: 24.2 min vs 28.4, 28.2, and 37.2 min) and waiting times (average: 8.0 min vs 12.5, 12.3, and 20.5 min) for scheduled patients compared with other registration strategies. CONCLUSION: The findings of this research could be applied possibly to any outpatient clinic with mixed-registration-type (walk-in and scheduled), particularly which accounts for high percentage of walk-in patients.

Appointments and Schedules↗