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PubMedDate not supplied

Artificial airways: a survey of cuff management practices.

OBJECTIVE: To determine current endotracheal and tracheostomy tube cuff management practices in adult and pediatric populations, and to compare current adult cuff management practice with those reported in use in 1984 and 1987. DESIGN: Descriptive survey. SETTING: Sixty-four acute care hospitals in the northeastern United States. SAMPLE: Responders represented 93 critical care units: 59 adult and 34 pediatric units. MEASUREMENTS: Subjects completed a survey questionnaire. RESULTS: Forty-one percent reported cuffs were routinely deflated, with most (88%) reporting cuff deflation every 8 to 12 hours or daily. In the pediatric population, minimal occlusive volume was the most frequent technique (29%); whereas in the adult population, both minimal occlusive volume technique and minimal leak technique were used more frequently (36%). Most (93%) cuff pressures were measured every 8 to 12 hours or daily with a recommended maximum range of 20 to 30 mm Hg. Cuff deflation and cuff inflation were performed more often by the nursing staff (36%). Cuff pressures were performed more often by respiratory staff (71%). There were no statistically significant differences in the cuff management practices between the adult and pediatric populations. In comparing the results for adults to the data of 1984 and 1987, most cuff management practices changed from every 8 hours or less to every 8 to 12 hours or daily, and the nursing responsibility for these techniques increased (22%). CONCLUSION: Most responders do not routinely deflate cuffs. Cuff management practices are performed less frequently, and nursing responsibility for these techniques has increased.

Adult↗
PubMed2005

Program directors in surgery agree that residents should be formally trained in business and practice management.

BACKGROUND: Surgical residents typically receive limited exposure to business and practice management during their training. As a result, residents are ill-prepared for issues related to starting a practice, coding, collecting, and taking a meaningful role within the medical community in promoting quality and safety and in containing health care costs. With the introduction of the core competencies and the current overhaul of surgical education, we believe there is an opportunity to include business and practice management into resident training. METHODS: Program directors in general surgery (189 of 242) responded to a 9-question mailed survey inquiring about their opinions regarding training surgical residents in business and practice management. RESULTS: Most program directors agreed or strongly agreed (87%) that residents should be trained in business and practice management. Seventy percent believed that their current trainees were inadequately trained in this area. Over half (63%) believed that this training should begin during postgraduate years 2 to 5. CONCLUSIONS: Development of simple curricula aimed at preparing surgical residents for business and practice management could promote the contemporary education of surgeons.

Adult↗
PubMed2002

Organizational safety: which management practices are most effective in reducing employee injury rates?

PROBLEM: While several management practices have been cited as important components of safety programs, how much does each incrementally contribute to injury reduction? This study examined the degree to which six management practices frequently included in safety programs (management commitment, rewards, communication and feedback, selection, training, and participation) contributed to a safe work environment for hospital employees. METHOD: Participants were solicited via telephone to participate in a research study concerning hospital risk management. Sixty-two hospitals provided data concerning management practices and employee injuries. RESULTS: Overall, the management practices reliably predicted injury rates. A factor analysis performed on the management practices scale resulted in the development of six factor scales. A multiple regression performed on these factor scales found that proactive practices reliably predicted injury rates. Remedial measures acted as a suppressor variable. DISCUSSION: While most of the participating hospitals implemented reactive practices (fixing problems once they have occurred), what differentiated the hospitals with low injury rates was that they also employed proactive measures to prevent accidents. IMPACT ON INDUSTRY: The most effective step that hospitals can take is in the front-end hiring and training of new personnel. They should also ensure that the risk management position has a management-level classification. This study also demonstrated that training in itself is not adequate.

Accidents, Occupational↗
PubMed2005

Physician evaluations of care management practices in Medicaid programs.

OBJECTIVE: To assess differences in care management practices for Medicaid beneficiaries in predominantly commercial and predominantly Medicaid health plans. STUDY DESIGN: Physicians in the networks of 8 managed care plans participating in Medicaid programs were surveyed regarding the availability and usefulness of care management practices and the overall quality of care management. The responses of physicians in plans serving predominantly Medicaid enrollees were contrasted with the responses of physicians in predominantly commercial plans who cared for Medicaid enrollees. METHODS: Logistic regression analysis was used to calculate adjusted odds ratios relating to the availability of care management practices. Multiple regression techniques were used to construct comparisons of adjusted means relating to the usefulness of practices and the overall quality of care management. RESULTS: Physicians in predominantly commercial plans reported greater availability of care management practices. No patterns of differences were noted in ratings of the usefulness of practices if available. Physicians in predominantly commercial plans rated the quality of care management higher than physicians in predominantly Medicaid plans. However, there remains room for substantial improvement for commercial and other Medicaid contracting plans. CONCLUSIONS: Commercial plans add value to Medicaid programs, and efforts to discourage their withdrawal from participation are justified. However, physician evaluations support the potential for better care management in all types of contracting plans.

Adult↗
PubMed2002

Asthma control and differences in management practices across seven European countries.

Failure to follow asthma management guidelines may result in poor asthma control for many patients. The Asthma Insights and Reality in Europe (AIRE) survey, a multi-national survey assessing the level of asthma control from the patients perspective in seven Western European countries, previously demonstrated that the Global Initiative for Asthma (GINA) guideline goals were not achieved in Western Europe and that both adults and children with asthma were poorly controlled. Using additional data on asthma management practices from each of the seven countries in the AIRE survey, we compared variations in asthma morbidity and asthma management practices across countries to provide insight into the reasons for poor asthma control. Asthma management practices and asthma control among adults and children with current asthma were suboptimal in each of seven countries surveyed. Among patients with symptoms of severe persistent asthma, over 40% reported their asthma was well or completely controlled. School absence due to asthma was reported by upto 52.7% of children and up to 27.6% of adult reported work absence due to asthma. Lung function testing in the past year was uncommon: ranging from 13.5% of children in the U.K. to 68.8% of adults in Germany. Written asthma management plans were used by less than 50% of adults and less than 61% of children in all seven countries. Most adults (49.5-73.0%) and a large proportion of children (38.4-70.6%) had follow-up visits for their asthma only when problems developed. The ratio of recent inhaled corticosteroid use to recent short-acting beta-agonist use was inappropriate (<1) among patients with symptoms of severe asthma in all countries. This disparity was greatest among adults in Italy and France, where recent inhaled corticosteroid use was reported by less than one in nine patients reporting recent use of short-acting bronchodialators (IS:SAB <0.11). Management practices differ between countries and additional public health interventions and resources may be necessary to reduce patient suffering. Further efforts to fully implement asthma management guidelines are required to improve asthma control in Europe.

Adolescent↗
PubMed1999

Determinants of specialty physician practice management integration.

Physicians increasingly organize strategically to mitigate the potentially adverse impacts of managed care on practice incomes. There are alternative routes to physician organizing. This article used a 1996-1997 survey of orthopedics and obstetrics-gynecology (OB-GYN) practices in Memphis, Tennessee (a large medical services market), to investigate the determinants of specialty physician integration through physician practice management (PPM) firms. The percentage of managed care contracts indicates a weak but positive correlation with PPM integration. Different factors appear to influence the likelihood of integration in different specialties. Probit model results of the OB-GYN data suggest the increased likelihood of integration in practices with at least seven physicians. The probability of PPM integration is associated with significant economies of scale in the number of non-physician clinical employees per physician. Probit estimates of the orthopedics specialty indicate the likelihood for integration as significantly inversely related to the total number of clinical and non-clinical employees. Given physical capital intensity in orthopedics, the exhaustion of scale economies at a lower level of an integrated practice employment is expected. The strong predictive power of the probit model estimates makes it a useful tool for predicting the likelihood that a randomly chosen specialty practice is integrated.

Economics, Medical↗
PubMed2002

Racial/ethnic variation in asthma status and management practices among children in managed medicaid.

OBJECTIVE: Racial/ethnic disparities in hospitalization rates among children with asthma have been documented but are not well-understood. Medicaid programs, which serve many minority children, have markedly increased their use of managed care in recent years. It is unknown whether racial/ethnic disparities in health care use or other processes of care exist in managed Medicaid populations. This study of Medicaid-insured children with asthma in 5 managed care organizations aimed to 1) compare parent-reported health status and asthma care processes among black, Latino, and white children and 2) test the hypothesis that racial/ethnic variations in processes of asthma care exist after adjusting for socioeconomic status and asthma status. METHODS: This cross-sectional study collected data via telephone interviews with parents and computerized records for Medicaid-insured children with asthma in 5 managed care organizations in California, Washington, and Massachusetts. The American Academy of Pediatrics (AAP) Children's Health Survey for Asthma was used to measure parent-reported asthma status. We used multivariate models to evaluate associations between race/ethnicity and asthma status while controlling for other sociodemographic variables. We evaluated racial/ethnic variations in selected processes of asthma care while controlling for other demographic variables and asthma status. RESULTS: The response rate was 63%. Of the 1658 children in the respondent group, 38% were black, 19% were Latino, and 31% were white. Black children had worse asthma status than white children on the basis of the AAP asthma physical and emotional health scores, symptom-days, and school days missed in the past 2 weeks. Latino children had equivalent AAP scores but missed more school days than white children. On the basis of the AAP asthma physical health score, the black-white disparity persisted after adjusting for other sociodemographic variables. After adjusting for sociodemographic variables and asthma status, black and Latino children were less likely to be using inhaled antiinflammatory medication than white children (relative risk for blacks: 0.69; relative risk for Latinos: 0.58). They were more likely to have home nebulizers. Other processes of asthma care, including ratings of providers and asthma care, use of written management plans, use of preventive visits and specialists, and having no pets or smokers at home, were equal or better for minority children compared with white children. CONCLUSIONS: Black and Latino children had worse asthma status and less use of preventive asthma medications than white children within the same managed Medicaid populations. Most other processes of asthma care seemed to be equal or better for minorities in the populations that we studied. Increasing the use of preventive medications is a natural focus for reducing racial disparities in asthma.

Black or African American↗
PubMed1991

Computers in dental practice management.

More and more, dentists are using computers to manage their practices. This review discusses current trends in computer use, operating systems, and software among dentists. It also discusses how computers make a dental practice more efficient.

Humans↗