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PubMed2003

From DRG databases to an epidemiological observatory for colorectal cancer in a French small area oncology network.

Following a request from the local health authority, we have organised the permanent linkage of DRG/MBDS databases from different tertiary care hospitals from Saint-Etienne urban area. To made anonymous the MBDS, we used the asymmetric hashing and encrypting software developed and registered by the University hospital of Dijon. In each hospital, the selection of acute care stay MBDS is performed on the presence of at least one malignant tumour ICD code. The output is an anonymous but personal 20,000 patients register. We are presenting the method to estimate the incidence of colorectal cancer (CRC) cured between 1996 and 2000 from DRG databases of four hospitals and checking the validity against the figures coming from a cancer registry. Among the 1953 CRC patients observed, 156 patients have followed a CRC surgical excising in 1999. The DRG activity of the 4 observatory hospitals is 33.5% of the total hospital activity for people of the area recorded by the 1999 regional DRG PMSI data bases. The estimation of the incidence is 465 for 1999, the estimation of the same incidence by applying the incidence rate by sex and age from the Isère cancer register to the population of the Loire area, is 504. The under estimation is 7.7% with the observatory method. It is rather difficult to check an estimation by another estimation but in France the evaluation of oncology care strategies is impeded by the lack of cancer registries. The conclusion of this study is a good feasibility and acceptability of the linking procedure when used with a clear healthcare goal. The use of DRG data bases within an oncology network by linking the mandatory MBDS data bases gives the opportunity to share some clinical data between healthcare professionals.

Colorectal Neoplasms↗
PubMed2003

The Danish National Health Informatics Strategy.

The central vision for the future information systems in the Danish health care sector is one of a generally accepted, common information model enabling comprehensive digital reuse of shared clinical data. A generic 'Basic-EHR-structure' has been developed for this purpose by the National Board of Health from a through analysis of the production of clinical information. The strategy contributes to the achievement of the national political goals for the health care sector and describes four important steps to be made by the health care IT systems in order to reach full interoperability and digital reusability of clinical information. Some important initiatives of the strategy are a national terminology server, coordinated implementation of EHRs, and the Public Health Information Portal.

Denmark↗
PubMed2004

Polycystic ovary syndrome and type 2 diabetes mellitus.

Polycystic ovary syndrome (PCOS) is a medical condition that has brought multiple specialists together. Gynecologists, endocrinologists, cardiologists, pediatricians, and dermatologists are all concerned with PCOS patients and share research data and design clinical trials to learn more about the syndrome. Insulin resistance is a common feature of PCOS and is more marked in obese women, suggesting that PCOS and obesity have a synergistic effect on the magnitude of the insulin disorder. It leads to increased insulin secretion by beta-cells and compensatory hyperinsulinemia. Hyperinsulinemia associated with insulin resistance has been causally linked to all features of the syndrome, such as hyperandrogenism, reproductive disorders, acne, hirsutism and metabolic disturbances. If beta-cell compensatory response declines, relative or absolute insulin insufficiency develops which may lead to glucose intolerance and type 2 diabetes. Moreover, insulin resistance in PCOS may be considered a risk factor for gestational diabetes (GD).

Adult↗
PubMedDate not supplied

The student/faculty international exchange: responding to the challenge of developing a global perspective in nursing education.

A student/faculty international exchange is an effective means for nursing programs to respond to the challenge of developing a global perspective in nursing education. This article explores the use of a student/faculty exchange as an intervention to help facilitate an international partnership. Bandura's social learning theory provides the conceptual framework to model the exchange, a collaborative effort that offers faculty and students the opportunity to acquire an international view of health care by comparing and sharing nursing data across populations, settings, and geographic areas. Strategies for developing a successful exchange program, obstacles involved in the process, and evaluation methods are addressed.

Attitude of Health Personnel↗
PubMed2004

Tying up lions: multilateral initiative on malaria communications: the first chapter of a malaria research network in Africa.

"When spider webs unite, they can tie up a lion" (Ethiopian folk adage). The Multilateral Initiative on Malaria Communications Network (MIMCom) facilitates a new way of doing research in Africa and African scientists' participation in the international scientific community. The MIMCom supports full access to the Internet and the resources of the WorldWide Web at 19 research sites in 11 African countries. Furthermore, the MIMCom project comprises two websites: one includes links to resources, databases, and publications as well as a document delivery service for full text journal articles, and the other is a research agenda specific website with a server for a research network desiring to share raw data. Other important components of MIMCom are training and evaluation components. The MIMCom was conceived in 1997 by African researchers and has been designed, implemented, and overseen by the U.S. National Library of Medicine in collaboration with partners in Africa, the United States, and the United Kingdom. This project demonstrates clearly that it can make a positive difference in the functioning of remote research sites in Africa, in terms of site growth and productivity and in the professional lives of individual researchers. This report reviews the project's background, methods of operation with an emphasis on local needs and priorities, cost effectiveness, and local responsibility; results focusing on a technical network; documentation of the system and two-way exchange of information; the MIMCom website; a network approach to research; and financial sustainability. The report concludes with summaries of evaluations by an independent panel, the Multilateral Initiative on Malaria Secretariat, and the U.S. National Library of Medicine.

Africa↗
PubMed2004

Picture archiving and communication systems.

Picture archiving and communication systems (PACS) are highly versatile data storage and retrieval systems that facilitate the transfer of digital images and patient data throughout a healthcare enterprise. Typically, they process images from diagnostic imaging modalities and are interfaced to radiology information systems (RISs) and hospital information systems (HISs) to improve overall workflow. For this Evaluation, we tested six PACS from six suppliers. Ideally, a PACS should allow the healthcare facility to achieve a fully automated workflow, in which patient image data is shared seamlessly from one system to another within a single electronic medical record (EMR). Although our testing found that this ideal has not yet been completely realized, many of the evaluated systems have taken significant steps in that direction. This Evaluation was limited to radiology PACS; however, more and more facilities are considering single PACS solutions to cover the needs of all their imaging departments.

Humans↗
PubMed2004

The open organization. Interview by Mary Grayson.

Richard Umbdenstock, chair-elect of the AHA, believes that the advent of benchmarking and comparative databases is one of the best things to happen to hospitals. And sharing that data and other information with the public will strengthen hospitals' relationships with their communities, says the CEO and president of Providence Services, Spokane, Wash.

American Hospital Association↗
PubMed1992

Multiple sources of Medicare supplementary insurance.

Estimates from the National Medical Expenditure Survey imply that in 1987 only two-thirds of elderly Medicare beneficiaries held the amount and type of insurance that is generally recommended to supplement Medicare, namely, 57.7% with private hospital/medical insurance from one source and 6.6% with only Medicaid. Of the remainder, 19.8% had more than one source of private insurance; slightly more than 1% had one source of extra-cash or disease-specific insurance as their only supplementary coverage; and 12.9% had no supplementary coverage at all. In addition, more than 500,000 Medicaid enrollees had purchased private insurance, despite the comprehensive coverage offered by Medicaid. Although the issue of multiple coverage has been dramatized by stories of poor, very elderly persons who have purchased numerous Medigap plans, beneficiaries who purchase coverage from more than one source are likely to be relatively young, more highly educated, and financially better off.

Age Factors↗
PubMed2004

Using survey data for diabetes surveillance among minority populations: a report of the Centers for Disease Control and Prevention's expert panel meeting.

INTRODUCTION: Data on diabetes morbidity and mortality and the quality of care among U.S. minority populations are necessary to assess progress toward eliminating racial/ethnic disparities and to design and implement effective interventions. This paper summarizes the discussions and recommendations of an expert panel to address the use of survey data for diabetes surveillance among minority populations. METHODS: The Centers for Disease Control and Prevention's Division of Diabetes Translation convened an expert panel of persons with survey experience and awareness of the problems in conducting health-related surveys among minority populations. Panel members were asked to 1) determine ways to enhance the ability of existing survey systems to address diabetes surveillance among minority populations; 2) identify survey systems that could be used to address surveillance needs; and 3) determine whether new minority-specific survey systems need to be developed. RESULTS: Panel members concluded that, although no existing survey system is completely adequate for diabetes surveillance among minority populations, new systems should not be developed. They recommended 1) investigating the use of community-based surveys; 2) exploring the ability of national surveys to increase sample sizes and produce state-level estimates; and 3) encouraging government agencies and public health programs to coordinate and integrate diabetes-related survey data and share analytic methodology. CONCLUSION: No existing survey is suitable for conducting minority-specific diabetes surveillance. Modifying and expanding existing surveys to establish a diabetes surveillance system of sentinel minority populations would be more feasible than developing a new one. Interagency coordination and collaboration will be critical in this effort.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

Health care consumerism: engaging the real buyers--employees.

Many employers have begun moving toward health care consumerism strategies designed to encourage employees to take more responsibility for their health care and the cost of that care. Recent surveys suggest ways employers can ensure their consumerism strategies succeed in engaging employees and, ultimately, encourage employees to change their behavior. This article describes what those surveys reveal about employer and employee perspectives on consumerism and suggests steps employers can take to align their interests with those of their employees in order to manage the demand for and use of health care.

Choice Behavior↗
PubMed2005

Evaluating the nondrug costs of formulary coverage restrictions.

PURPOSE: Clinicians often are required to switch prescribed therapy for their patients in response to health plan initiatives for controlling drug expenditures. To explore the effect of these initiatives, we sought clinicians' feedback regarding their practices and processes for switching patients' medications to accommodate insurance coverage. DESIGN: Self-administered Intranet-based survey of clinicians at an urban, tertiary-care hospital. METHODOLOGY: Using survey responses, we calculate nondrug costs induced by formulary cost-saving measures. PRINCIPAL FINDINGS: A total of 91 responses were received from 569 providers who were sent a request to complete the questionnaire via electronic mail (18 percent response rate). It took an average of 11.1, 18.9, and 16.4 minutes for physicians, nurses, and nurse practitioners/physician assistants, respectively, to make the medication switch. The mean number of switches per month ranged from 10.6 to 36.9. More than half the time spent on these switches is not directly reimbursed. Specific switch-induced intervention costs differed for different drug types. The effect on clinician workload tended to be an inconvenience. While the majority of physicians and nurse practitioners/physician assistants did not feel this process damaged patient-provider relations, most nurses did. CONCLUSIONS: In response to formulary restrictions, other costs are induced and incurred by providers and patients. The extent of patient costs, including those from adverse drug reactions, needs further study. More research is needed to elucidate costs and burden shifts as all parties involved evaluate and modify plans to moderate prescription drug expenditures.

Cost Control↗
PubMed2006

Evidence-based dentistry: fundamentals for the dentist.

This article explains the fundamentals of evidence-based dentistry for the dentist. Evidence-based dentistry is a discipline whose primary participant is the translational researcher. Recent developments have emphasized the importance of this discipline (clinical and translational research) for improving health care. The process of evidence-based dentistry is the reciprocation of new and existing evidence between dentists and quantitative and qualitative researchers, facilitated by the translational researcher. The product of this reciprocation is the clinical practice guideline, or best evidence, that provides the patient options in choosing treatments or services. These options are quantified and qualified by decision, utility, and cost data. Using shared decision-making, the dentist and patient arrive at a mutual understanding of which option best meets an acceptable and preferred treatment course that is cost effective. This option becomes the clinical decision.

Decision Making↗