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Data Library: providers in the nation's most successful medical groups perform more procedures, use their physical space more efficiently, and have more support staff than those in peer organizations, according to these study results recently released by the Medical Group Management Association.
How does your HMO stack up against its peers where administrative costs are concerned? Data from a survey conducted by Sherlock Company of six large HMOs was broken out into six product lines and 15 major functions, and then analyzed three ways. Check out the results.
Cost reduction in the management of common surgical diseases such as appendicitis has become paramount for the survival of children's hospitals. We designed a clinical pathway to treat appendicitis with the goal of reducing cost and hospital length of stay (LOS) while maintaining quality of care. From September 1995 through December 1996, patients with nonperforated appendicitis (NPApp) and perforated appendicitis with peritonitis (PApp) were enrolled into a clinical pathway. NPApp patients were discharged when tolerating a regular diet. PApp patients were discharged if the following criteria were met: temperature < 38.5 degrees C for 24 hours, WBC < 14,000 on postoperative day 3, tolerating diet, and transition to oral analgesics accomplished. Hospital LOS and actual hospital costs in pathway patients were compared with those of historic controls. Patients with appendicitis from the Pediatric Health Information Systems (PHIS) database, a consortium of 20 children's hospitals in the United States, served as concurrent controls. Hospital LOS and hospital charges in PHIS NPApp and PApp patients from our institution were compared with national PHIS database patients. Mean LOS and hospital costs for both NPApp and PApp pathway patients were significantly decreased compared with historic controls (P < 0.05). Mean LOS and hospital charges in our institution's PHIS NPApp and PApp patients were also significantly decreased compared with the national PHIS database (P < 0.05). Innovative approaches such as these are necessary for the survival of children's hospitals in an increasingly cost competitive healthcare market.
OBJECTIVE: An exploratory examination of the technical efficiency of organ procurement organizations (OPOs) relative to optimal patterns of production in the population of OPOs in the United States. DATA SOURCES: A composite data set with the OPO as the unit of analysis, constructed from a 1995 national survey of OPOs (n = 64), plus secondary data from the Association of Organ Procurement Organizations and the United Network for Organ Sharing. STUDY DESIGN: The study uses data envelopment analysis (DEA) to evaluate the technical efficiency of all OPOs. PRINCIPAL FINDINGS: Overall, six of the 22 larger OPOs (27 percent) are classified as inefficient, while 23 of the 42 smaller OPOs (55 percent) are classified as inefficient. Efficient OPOs recover significantly more kidneys and extrarenal organs; have higher operating expenses; and have more referrals, donors, extrarenal transplants, and kidney transplants. The quantities of hospital development personnel and other personnel, and formalization of hospital development activities in both small and large OPOs, do not significantly differ. CONCLUSIONS: Indications that larger OPOs are able to operate more efficiently relative to their peers suggest that smaller OPOs are more likely to benefit from technical assistance. More detailed information on the activities of OPO staff would help pinpoint activities that can increase OPO efficiency and referrals, and potentially improve outcomes for large numbers of patients awaiting transplants.
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A detailed database containing information on patients and practice patterns can be a positive force in efforts to lower cesarean rates. Women's Hospital at Saddleback Memorial Medical Center in Laguna Hills, CA, utilizes an in-house, custom database, known as OBSTAT, to collect and store obstetrical clinical data. Use of OBSTAT has correlated positively with a reduction in cesarean rates at Women's Hospital.
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California became the first state to require all patient care units in hospitals to meet fixed minimum nurse-to-patient ratios. In a hospital environment where patients are sicker, and care is more complex, according to American Nurses Association (ANA) president Beverly L. Malone, "Cutting the numbers of RNs and substituting unlicensed aides for registered nurses are exactly the wrong moves." ANA's "Principles of Nurse Staffing" call for staffing decisions to be made on the basis of three sets of principles: those related to patient care, staff-related issues, and institution/organization concerns. The California legislation currently contains no specific numerical requirements. ANA's 10 Nursing-Sensitive Quality Indicators for Acute Care Settings is comprised of a series of measures that represent the nursing community's current conception of how nurse staffing levels impact patient care.