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PubMed2002

Meeting patient expectations: healthcare professionals and service re-engineering.

A central theme underpinning the reform of healthcare systems in western economies since the 1980s has been the emphasis on reorienting service provision around the patient. Healthcare organizations have been forced to re-appraise the design of the service delivery process, specifically the service encounter, to take account of these changing patient expectations. This reorientation of healthcare services around the patient has fundamental implications for healthcare professionals, specifically challenging the dominance of service professionals in the design and delivery of health services. Utilizing a qualitative methodological framework, this paper explores the responses of healthcare professionals to service redesign initiatives implemented in acute NHS hospitals in Scotland and considers the implications of such professional responses for the development of patient-focused service delivery. Within this, it specifically examines evolving professional perspectives on the place of a service user focus in a publicly funded healthcare system, professional attitudes towards private sector managerial practices, and the dynamics of changing professional behaviour.

Attitude of Health Personnel↗
PubMed2002

Are longer hospital stays beneficial for the elderly?

Utilization review is a way to manage healthcare costs and is widespread in Canada, as managers attempt to use available acute-care beds in a best practice manner. As we reduce beds and decrease length of stay, we often wonder if the outcomes for patients are affected, particularly if the patients are elderly.

Aged↗
PubMed2000

Mental health parity legislation: much ado about nothing?

OBJECTIVE: To determine whether state-level parity legislation has led to an increase in utilization of mental health services. DATA SOURCES: Healthcare For Communities (HCC), a multi-site nationally representative study sponsored by the Robert Wood Johnson Foundation that tracks health care system changes for mental health and substance abuse treatment. Information on state-level parity legislation was provided by state offices of the National Alliance for the Mentally Ill (NAMI); local and state market data come from the Area Resource File; information on other health mandates from Blue Cross/Blue Shield. STUDY DESIGN: Two-stage regressions are used to estimate the effect of state parity legislation on use of any mental health services, use of specialty mental health services, and number of specialty visits in the past year. In the first stage, we predicted the probability that a state decides to pass parity legislation as a function of state health care market indicators and previous legislative activity. The fitted probability is used in the second stage to determine the effect of this legislation on access and utilization. PRINCIPAL FINDINGS: State parity legislation is not associated with a significant increase in any of our measures of mental health services utilization. These results are robust to various specifications of the models. CONCLUSIONS: Those states that are able to pass parity legislation do not experience significant increases in the utilization of mental health services. This may be due in part to a loss of coverage for those people most at risk for mental health disorders. The results could be very different, however, if strong federal legislation were passed.

Health Policy↗
PubMed1995

The effect of ambulatory oncology nursing practice models on health resource utilization. Part 2, Different practice models--different use of health resources?

The continuous rise in healthcare expenditures concerns providers, recipients, and payers alike, all of whom seek to explain, justify, or contain these costs. Although nurses are major healthcare providers in ambulatory oncology settings, the efficiency or productivity of nursing, expressed as frequency and cost of services (resource utilization), has not been addressed. Part 1 presented findings from a retrospective comparative study that delineated two different models of oncology nursing practice, the Nurse Complement Model and the Nurse Substitute Model of practice. Part 2 discusses these differences in the economic effectiveness of ambulatory oncology nursing in terms of health resource utilization.

Breast Neoplasms↗
PubMed1996

Providing cost data to physicians helps contain costs.

Findings of a survey of 1,200 physicians suggest that healthcare organizations that provide physicians with pricing information can reduce resource utilization and control costs more effectively than organizations that do not provide such information. These findings also suggest that healthcare financial managers who are aware of physicians' responses to cost information--and who furnish them with effective cost information--may gain a timely competitive advantage.

Awareness↗
PubMedDate not supplied

Socio-cultural information in support of local health planning: conclusions from a survey in rural Kenya.

Existing health information systems in developing countries are managed and used mainly by biomedically trained personnel and by general healthcare administrators. They focus on epidemiology, service utilization and finance; they generate little of the socio-cultural data needed for developing and adjusting health services and disease control programmes to local health-related perceptions, values and resources. This paper reviews some of the published literature on socio-cultural factors related to health and summarizes the findings of a health household interview study in rural Kenya. It concludes that local views on specific disease categories and their causes are crucial for the planning of local disease control and that health information systems need to be expanded to incorporate such data. It discusses methods of generating community-based socio-cultural health information likely to be useful, particularly at district level. Options include observation, household interviews, focus group discussions and key informant interviews. Four improvements are suggested: (1) health information systems should be reoriented to focus less on individual patients and clients and more on population-based information including socio-cultural data; (2) post-basic health manpower training is needed in applied health-related social sciences; (3) staff positions for social scientists at central, provincial and district levels of the health sector; and (4) expansion of research on national and local socio-cultural issues of relevance to health and care-seeking behaviour.

Community Health Planning↗
PubMed2003

Some historical remarks on picture archiving and communication systems.

This Special Issue contains one Editorial and 15 papers. The Editorial reviews some key events, conferences, and publications which propel PACS to its current status. The fifteen papers describe current and future PACS research and development trends grouped in four categories: system-wide trends and clinical experience, tools, key technologies, and PACS-based applications. We see that PACS has gradually become a necessary tool for daily clinical operation, its future trends will be in the development of research methods to fully utilize its large image database for better healthcare delivery.

Diffusion of Innovation↗
PubMed2000

A tool for quantifying hip flexor function during gait.

An index to measure the change in hip flexor function after hip surgery was developed in the Motion Analysis Laboratory at Gillette Children's Specialty Healthcare (GCSH). The hip flexor index (HFI) utilizes principal component analysis applied to five kinematic and kinetic variables collected during normal acquisition of gait data. A single index number is derived that describes accurately the overall hip function. Initial clinical validation was carried out using a data set of 23 normal controls and six patients with a diagnosis of cerebral palsy. The patients were all independent ambulators who had undergone orthopedic hip surgery. The controls were used to establish patterns of interdependency between selected gait parameters and form a basis for the index number. The HFI based surgical outcome was compared to the subjective rating of six clinicians. The clinicians were versed in gait analysis and were blinded to the HFI based outcome. The HFI measure of post-operative change in hip function was found to correspond well with the subjective clinical evaluation. A valid tool such as the HFI can be used to objectify clinical impressions of change in hip function, and can thereby assist researchers with statistical and outcome analysis of interdependent and redundant gait variables.

Biomechanical Phenomena↗
PubMed2006

Evaluation of the ambulatory and home care record: Agreement between self-reports and administrative data.

OBJECTIVES: Although measuring the utilization of ambulatory and home-based healthcare resources is an essential component of economic analyses, very little methodological attention has been devoted to the development and evaluation of resource costing tools. This study evaluated a newly developed tool, the Ambulatory and Home Care Record (AHCR), which comprehensively evaluates costs incurred by the health system and care recipients and their unpaid caregivers. METHODS: The level of agreement between self-reports from 110 cystic fibrosis care recipients and administrative data was assessed for four categories of health services: home-based visits with healthcare professionals, ambulatory visits with healthcare professionals, laboratory and diagnostic tests, and prescription medications. RESULTS: Agreement between care recipients' reports on the AHCR and administrative data ranged from moderate (kappa = 0.41; 95 percent confidence interval, 0.16-0.61) for physician specialist visits to perfect (kappa = 1.0) for physiotherapy visits. CONCLUSIONS: By evaluating and standardizing a resource and costing tool, such as the AHCR, economic evaluations may be improved and comparisons of the resource implications for different services and for diverse populations are possible.

Adult↗
PubMed2004

Reducing the use of emergency medical resources among Head Start families: a pilot study.

The objective of this study was to determine whether self-care training with Head Start parents can improve their ability to manage the healthcare needs of their children measured by utilization of emergency department (ED) and physician services. Four hundred and six families in Head Start agencies were included in the study. Parents were given a low-literate self-help book entitled What To Do When Your Child Gets Sick. The study design included using multiple-choice, pre-and post-intervention survey data. In a six month follow-up, parents who received the book reported a 48% reduction in ED visits and a 37.5% reduction in clinic visits. More research is needed to determine if this self-care tool and additional training can have a significant impact on inappropriate use of medical resources.

Attitude to Health↗
PubMed2003

Costs and consequences of stem cell transplantation in children.

Economic evaluation is a comparison of the costs and consequences of alternative healthcare interventions. Consequences are best assessed as utilities; quality-adjusted measures of effectiveness. Although few substantive data are available, it appears that hematopoietic stem cell transplantation is even more cost-effective in children than in adults.

Child↗
PubMed2002

Tuberculin skin testing among healthcare workers in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

OBJECTIVES: To determine the occupational risk of Mycobacterium tuberculosis infection among healthcare workers (HCWs) and to examine the utility of tuberculin skin testing in a developing country with a high prevalence of bacille Calmette-Guerin vaccination. DESIGN: Tuberculin skin test (TST) survey. SETTING: A tertiary-care referral center and a teaching hospital in Kuala Lumpur, Malaysia. PARTICIPANTS: HCWs from medical, surgical, and orthopedic wards. INTERVENTION: Tuberculin purified protein derivative RT-23 (State Serum Institute, Copenhagen, Denmark) was used for the TST (Mantoux method). RESULTS: One hundred thirty-seven (52.1%) and 69 (26.2%) of the HCWs tested had indurations of 10 mm or greater and 15 mm or greater, respectively. Medical ward HCWs were at significantly higher risk of a positive TST reaction than were surgical or orthopedic ward HCWs (odds ratio, 2.18; 95% confidence interval, 1.33 to 3.57; P = .002 for TST positivity at 10 mm or greater) (odds ratio, 2.61; 95% confidence interval, 1.44 to 4.70; P = .002 for TST positivity at 15 mm or greater). A previous TST was a significant risk factor for a positive TST reaction at either 10 mm or greater or 15 mm or greater, but a duration of employment of more than 1 year and being a nurse were only significantly associated with a positive TST reaction at a cut-off point of 15 mm or greater. CONCLUSIONS: HCWs at the University of Malaya Medical Centre had an increased risk for M. tuberculosis infection that was significantly associated with the level of occupational tuberculosis exposure. A TST cut-off point of 15 mm or greater may correlate better with M. tuberculosis infection than a cut-off point of 10 mm or greater in settings with a high prevalence of bacille Calmette-Guerin vaccination.

Cross Infection↗
PubMedDate not supplied

The impact of lay health advisors on cardiovascular health promotion: using a community-based participatory approach.

Overweight and obesity, lack of exercise, and exposure to tobacco smoke are clearly identified behavioral risk factors for cardiovascular disease. These problems disproportionately affect some communities. To address these problems within one community of underserved Latinos, participatory research methods were used to design an outreach program through a collaborative partnership between UCLA School of Nursing, Los Angeles County Department of Health Services, and members of the target community. Latina lay health advisors (LHAs) (n = 12) from the community were recruited and trained to teach 3 classes on healthy nutrition, physical activity, and maintaining smoke-free environments. Classes were offered in Spanish to adult Latinos recruited through the LHAs' social networks. A questionnaire on lifestyle behaviors was completed at baseline and 1 month following the last class. Exploratory open-ended questions on successes and challenges of applying new knowledge were also asked at follow-up. Results of paired t-tests on 256 participants showed significant increases in scores from baseline to follow-up in overall lifestyle behaviors and all 3 behavioral subsets (nutrition, physical activity, smoke-free behavior). Qualitative findings are also presented. Findings support utilizing LHAs as a feasible and effective healthcare delivery strategy for cardiovascular community health promotion, especially among immigrant populations.

Adolescent↗
PubMedDate not supplied

Using the World Wide Web in health-related intervention research. A review of controlled trials.

A review of published controlled trials was conducted to evaluate components, utility, and efficacy of Web-based healthcare interventions. Nine studies met the established review criteria. Knowledge gains were the most commonly reported significant changes; rarely were there measures or significant changes on behavioral outcomes. Studies varied in format of personal contact with participants, in the structure or sequence of intervention content, and in design features. Dosage was inconsistently measured and process evaluation was relatively absent. Despite limitations, several studies reported significant effects. Based on best evidence-to-date, elements of technologically mediated interventions important to future research are summarized. Taken together, research suggests that Web-based interventions may be an efficacious delivery system, especially for those with chronic conditions amenable to self-management and to those with various limitations to accessing healthcare.

Computer-Assisted Instruction↗
PubMedDate not supplied

Health problems and medical utilization associated with gambling disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: Pathologic gambling is believed to be associated with adverse health consequences, but no prior studies have rigorously evaluated these relationships. We sought to examine medical disorders and health service utilization associated with problem and pathologic gambling. METHOD: A total of 43,093 adults aged 18 years and older were evaluated in the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions. Self-reported medical diagnoses and past-year medical services used were assessed. RESULTS: Pathologic gamblers were more likely than low-risk individuals to have been diagnosed with tachycardia (odds ratio [OR] = 1.77; 95% confidence interval [CI] = 1.05-2.97), angina (OR = 2.35; 95% CI = 1.33-4.15), cirrhosis (OR = 3.90; 95% CI = 1.11-13.72), and other liver disease (OR = 2.98; 95% CI = 1.07-8.26). Gambling severity was also associated with higher rates of medical utilization with pathologic gamblers more likely than low-risk individuals to have been treated in the emergency room in the year before the survey (OR = 1.98; 95% CI = 1.27-3.09). Significant effects of gambling severity remained even after controlling for demographic characteristics (age, gender, ethnicity, marital status, education, income, and region of the country) and behavioral risk factors such as body mass index, alcohol abuse and dependence, nicotine dependence, and mood and anxiety disorders. CONCLUSIONS: A lifetime diagnosis of pathologic gambling is associated with several medical disorders and increased medical utilization, perhaps leading to a burden on healthcare costs in the United States.

Adolescent↗
PubMed2006

A prospective study investigating the cost effectiveness of intraoperative blood salvage during liver transplantation.

BACKGROUND: Adult orthotopic liver transplantation is associated with significant use of allogenic blood products, which places considerable demands on finite resources. This could be reduced by autologous red cell salvage use, and we evaluated its cost effectiveness in this prospective study. METHODS: Intraoperative autotransfusion was used in 660 adult liver transplant patients between January 1997 and July 2002. These included 134 with acute liver failure, 62 retransplants, 90 alcohol-related, 183 viral, 98 cholestatic chronic liver diseases, and 93 with other etiologies. RESULTS: The total volume of red blood cells transfused was 3641+/-315 ml, 2805+/-234 ml, 2603+/-443 ml, and 2785+/-337 ml for alcohol-related, viral, cholestatic, and others, respectively. Low preoperative hemoglobin was significantly associated with higher intraoperative transfusion requirements. Blood volumes transfused at retransplantation were significantly higher (7077+/-1110 ml vs. 2864+/-138 ml; P<0.001) than for acute liver failure and chronic liver disease. Autologous blood volumes transfused were similar in all diagnostic groups, but were significantly greater in retransplantation (2754+/-541 ml vs. 1524+/-77 ml; P<0.01). Venovenous bypass was significantly associated with higher transfusion requirements. Total savings per case were similar for all diagnostic groups but were greater in cases of retransplantation (864+/-222 pounds (1235+/-317 US dollars) vs. 238+/-24 pounds (340+/-34 US dollars; P<0.001). With the use of autologous transfusion over the study period, a cost saving of 131,901 pounds (188,618 US dollars) was achieved. CONCLUSIONS: Intraoperative red blood cell salvage and autologous transfusion is cost effective in adult liver transplantation. Currently, where optimum resource utilization and fiscal constraint are paramount in healthcare delivery, autologous transfusion is an important adjunct in liver transplantation.

Adult↗