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PubMed2002

Implementation of an X-ray radiation protective equipment inspection program.

In order to comply with the requirements established by healthcare organization accrediting agencies, radiation protective equipment (e.g., lead aprons, gloves, and collars) utilized by x-ray workers must be periodically evaluated for damage. The objective of such evaluations is to identify and remove from service equipment bearing large holes, tears, etc., that could compromise the safety of individuals using this equipment. Many facilities are cited each year for failing to ensure the availability and integrity of such equipment. Unfortunately, written guidance on the proper implementation of inspection programs is not readily available. This paper was developed to assist healthcare organization safety personnel in establishing a radiation protective equipment inspection program at their facilities.

Equipment Failure↗
PubMed1997

The validity and usage of resource utilization data among a group of primary care physicians.

The use of individual resource utilization scores to compare primary care physicians (PCPs) has become more commonplace as managed care organizations (MCOs) increase their penetration into the US healthcare market. This study looks at the validity and usage of these scores among a group of PCPs within a multispecialty clinic that is part of an integrated managed care network. Personal interviews were conducted with PCPs; and reviews were done of the practice site paper charts, the computerized visit record system of the clinic and affiliated hospital, and the MCO-supplied resource utilization data on the 25 patients of each PCP on whom the most healthcare dollars were spent in 1995. As of October 1996, few PCPs had done more than a cursory review of their resource utilization data. None had identified the patients who use the most resources or developed any methods to proactively manage those patients with a history of high utilization. The clinic's communication systems alerted the PCPs less than 50% of the time when patients for whom they were responsible had high utilization of services. Patients appeared to be assigned to the incorrect PCP more than 20% of the time. All players in this managed care network--PCPs, clinic administration, and the MCO--must work together to improve the current system before resource utilization data are considered valid and are incorporated more fully into clinical practice.

Efficiency, Organizational↗
PubMedDate not supplied

Stoma care: exploring the value of effective listening.

This article discusses how nurses can effectively utilize listening skills during interactions with patients. Listening is a core skill for all healthcare professionals with studies demonstrating that nurses perceive themselves to be much less skillful in the use of facilitative interpersonal skills which involve listening than practitioner centred authoritative ones. Listening effectively allows nurses to respond more completely to patients' needs but there are many obstacles which unfortunately can interfere with this process. Stoma care nurses utilize listening skills to ensure that both the physical and psychological needs of their patients are met. The author suggests that listening skills can enhance intuitive nursing practice.

Communication↗
PubMed1996

A primer on drug utilization review.

Many health care organizations evaluate drug utilization to improve the quality of patient care, reduce pharmaceutical expenditures, and enhance therapeutic outcomes. The Drug Regimen Review, instituted in 1974 as part of a quality assurance program for the care of Medicaid recipients, has reduced medication use, medication errors, adverse drug reactions, and drug-drug interactions. The Drug Usage Evaluation, a sophisticated analysis of drugs, their uses, and their contributions to various patient outcomes, is performed by member institutions of the Joint Commission on Accreditation of Healthcare Organizations. The 1990 Omnibus Budget Reconciliation Act (OBRA '90) established the Drug Utilization Review (DUR), which was implemented by state Medicaid outpatient prescription programs in 1993. Pharmacists performing DURs must review past patterns of drug misuse, monitor current therapy, and offer patient counseling. Drug utilization reviews have reduced inappropriate drug use and decreased drug costs.

Drug Utilization Review↗
PubMedDate not supplied

Utilizing the language of Jean Watson's caring theory within a computerized clinical documentation system.

The healthcare facility described in the following article is part of an eight-hospital organization that adopted Watson's Theory of Caring as part of their nursing philosophy. According to Watson, this theory is an attempt to find and deepen the language specific to nurse caring relations and its many meanings. Yet during the implementation of the theory within the setting described, it was noted that there was no mechanism in the current documentation system for clinical nursing staff to document the patient experience using any language specific to the theory. Nursing members recognized an opportunity to develop a new context in charting during an extensive clinical documentation system upgrade. A discussion of the steps taken and the results within the clinical documentation system supporting the newly adopted caring philosophy are summarized here.

Altruism↗
PubMed1978

Inpatient audit simplified.

One hospital's audit program identifies the necessary procedures for selecting criteria, performing audits, and conducting follow-up and shows how they can be accomplished most effectively and efficiently. In addition, it shows that a useful emergency department/outpatient audit can be conducted using data from telephone follow-up for the patients.

Anti-Bacterial Agents↗
PubMed2006

Care coordination and telehealth technology in promoting self-management among chronically ill patients.

With an increasingly complex healthcare system, the need to coordinate the care for chronically ill patient often goes unmet. This results in increased utilization of services at significant costs. In addition, providing patients with the tools to manage their own disease processes over the long term is also lacking in the healthcare environment. The Veterans Health Administration (VHA) approached these challenges by creating a Care Coordination program using technology to promote self management for veterans. Although a relatively new program, the Veterans Integrated Services Network (VISN) 7, has shown substantial gains in both decreasing the use of high cost care, such as emergency department (ED) visits and hospitalizations, as well as improving clinical outcomes with better glycemic control for patients with diabetes and improved lipid management for all patients.

Chronic Disease↗
PubMedDate not supplied

Utilization management: a rehabilitation approach to cost control.

Santa Rosa Rehabilitation Hospital in San Antonio, TX, not unlike many healthcare facilities throughout the nation, was faced with several issues: (a) increased cost, (b) lower reimbursement, (c) high length of stay, and (d) low staff morale. The management team was responsible for developing a system to control these issues, the most noticeable and measureable of which was length of stay. In 1987, the facility reached a high length of stay of 43 days. In response, the managers of Santa Rosa Rehabilitation Hospital took the lead in instituting multidisciplinary utilization management, and the hospital saw the average length of stay decrease to 18 days in 1990. This article provides a detailed description of the development of multidisciplinary utilization management, as well as a brief history of the rationale behind the utilization management process. Limitations and advantages of the system also are described.

Cost Control↗
PubMed2006

Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review.

AIM: This paper reports a systematic literature review examining relationships between contextual factors and research utilization in nursing, examining the strength of these relationships, and mapping the contextual factors to the Promoting Action on Research Implementation in Health Services model of research implementation. BACKGROUND: Healthcare organizations have long struggled with how to improve clinical care outcomes. Understanding which contextual factors enhance nursing research utilization may support organizations in creating environments that facilitate the uptake of evidence in nursing practice to improve these outcomes. METHODS: A search of five electronic bibliographic databases and a manual search of specific journals were conducted for studies that were published in English and examined contextual factors as independent variables and research utilization as the dependent variable from the perspective of nurses working in clinical practice. The studies were assessed for quality of design, sample, measurement and statistical analysis. RESULTS: Ten papers met the search criteria. Six contextual factors were identified as having a statistically significant relationship with research utilization, namely the role of the nurse, multi-faceted access to resources, organizational climate, multi-faceted support, time for research activities and provision of education. The contextual factors could successfully be mapped to the dimensions of context in the Promoting Action on Research Implementation in Health Services framework (context, culture, leadership), with the exception of evaluation. CONCLUSION: The strength of the relationship between the six contextual factors and research utilization by nurses is still largely unknown as (a) few studies were found of sufficient quality because of methodological limitations and (b) the results in reviewed studies were mixed. More robust methods in future work would yield a better understanding of the full impact of contextual factors on nurses' use of research.

Attitude of Health Personnel↗
PubMed2002

Diabetes disease management program for an indigent population empowered by telemedicine technology.

Mercy Health Center in Laredo, Texas implemented a Telemedicine Diabetes Disease Management Program to determine the impact of a web-based patient interface technology as part of a diabetes disease management program. The program featured the use of the Health Hero iCare Desktop and the Health Buddy appliance. The Mercy Health Center outcomes study aimed to assess the effect of telemedicine technology on the health of indigent border residents with diabetes. The study was conducted in calendar year 2000-2001 using comparative cohort data from calendar year 1999. Using the technology, patients were monitored daily at home, and to ensure early intervention, nurses were alerted if patients reported abnormalities. The goals of the program were to decrease hospital-based resource utilization, improve patient compliance with treatment plans, improve the level of patient satisfaction with healthcare services, and improve patients' perceived quality of life. Objective outcomes, including inpatient admissions, emergency room visits, postdischarge care visits, and outpatient visits, as well as charges for healthcare services, were all measured on a per patient per year basis. Subjective outcomes, including quality of life and patient satisfaction, were estimated from surveys conducted before, quarterly for two quarters within the program, and at the end of the study period. For each measure except for quality of life, comparisons were made between the year just prior to and the year of Health Buddy utilization. Quality of life was compared for the year just prior to Health Buddy utilization and at the end of the second quarter. After 1 year, reductions in overall utilization and charges, as well as improvements in quality of life, were demonstrated. Patients in the program showed reduced overall charges of 747 dollars per patient per year. Inpatient admissions were reduced 32% (p < 0.07), emergency room encounters were reduced 34% (p < 0.06), postdischarge care visits were reduced 44% (p < 0.28), and outpatient visits were reduced 49% (p < 0.001). Quality of life was assessed using the Medical Outcomes Study 12-item Short Form health survey. The mean improvement in the mental component after 6 months in the program was 2.8, from 45.1 preprogram to 47.9 within the program (p < 0.0264). The mean improvement in the physical component after 6 months in the program was 2.1, from 41.7 preprogram to 43.8 within the program (p < 0.0518). The reductions in utilization and improvement in quality of life can likely be attributed to the patient's enhanced self-management behaviors and the nurse's ability to intervene in a timely manner when warranted. Without technology and daily remote monitoring, standard patient care is based on episodic encounters between patients and their care providers, which does not allow for prevention, education, or early intervention. This program bridged the gap between office visits for the patients. The early intervention ultimately reduced the cost of care.

Diabetes Mellitus↗
PubMed1997

An ethics framework for assisting clinician-managers in resource allocation decision making.

In response to continued pressure on the Canadian healthcare system, hospitals are implementing structural changes to address issues of cost containment, utilization, and resource allocation. One strategy has been to decentralize managerial decision making to clinicians, creating "clinician-managers" (CMs). We surveyed 3,000 hospital-based CMs in Ontario, Canada (including physicians, nurses, and other health professionals), in order to understand the nature and frequency of the ethical issues they face as a consequence of their involvement in resource allocation decisions, and to identify mechanisms for dealing with these problems in their hospitals. Based on the survey results, we developed a Management Ethics Framework to assist CMs to reach an ethically justifiable resolution of these types of problems, both individually, and in the context of their membership in the healthcare team. The results, and particularly the discussion that follows, represent a confluence of philosophical, clinical, and organizational perspective on ethics and resource allocation by clinicians.

Attitude of Health Personnel↗
PubMed1989

Severity systems add new dimension to utilization management.

Utilization management expands the concept of utilization review by identifying the best possible treatment protocol for a specific type of patient. Severity of illness systems allow healthcare organizations to define patient groups with similar treatment needs and then identify appropriate practice patterns for each group. Both measures are critical to the success of a utilization management program.

Clinical Protocols↗
PubMed2004

A review of controlled substances.

Physicians who understand the Controlled Substances Act and their regulations will have fewer complications and problems. The tracking/monitoring system helps protect physicians and their patients from problems with abuse and diversion. The understanding that pharmacists are utilizing their skills everyday in reviewing a patient's pharmaceutical history and aiding the patient will no doubt encourage increased interaction among the healthcare fields and increase the quality of treatment for the patient.

Drug Utilization↗
PubMedDate not supplied

[Drug expenditure in primary care: associated variables and allocation of drug budgets according to health district].

OBJECTIVES: Identify factors explaining variability in prescribing costs after reviewing ecological data related to costs and socio-demographic characteristics of the health care zones in the autonomous region of Valencia, and explore the usefulness of using the model to set prescribing budgets in basic healthcare zones. MATERIALS AND METHODS: An ecological analysis of the value socio-demographic characteristics and use of healthcare services to explain prescribing costs in 1997. Development of a prediction model based on multiple linear regression in data for prescribing costs in 1997 and validation in data for 1998. RESULTS: Factors that correlated positively with prescribing costs were the percentage of inhabitants over the age of 80, the death rate, the percentage of inhabitants with only primary education or less, the percentage of inhabitants between the ages of 65 and 79 and the distance from the capital city. A multivariate model including the death rate, the percentage of inhabitants 80 years of age and older, the number of cars per 100 inhabitants and number of visits per inhabitant accounted for 44.5% of the variations in prescribing costs in 1997 and 32% in 1998. CONCLUSIONS: Socio-demographic factors and certain variables associated with health care utilization can be applied, within certain limitations, to set prescribing budgets in basic healthcare zones.

Budgets↗
PubMed2006

Impact of recipient MELD score on resource utilization.

The model for end stage liver disease (MELD) system prioritizes deceased donor organs to the sickest patients who historically require higher healthcare expenditures. Limited information exists regarding the association of recipient MELD score with resource use. Adult recipients of a primary liver allograft (n = 222) performed at a single center in the first 27 months of the MELD system were analyzed. Costs were obtained for each recipient for the 12 defined categories of resource utilization from the time of transplant until discharge. True (calculated) MELD scores were used. Inpatient transplant costs were significantly associated with recipient MELD score (r = 0.20; p = 0.002). Overall 1-year patient survival was 85.0% and was not associated with MELD score (p = 0.57, log rank test). Recipient MELD score was significantly associated with costs for pharmacy, laboratories, radiology, dialysis and physical therapy. Multivariate linear regression revealed that MELD score was most strongly associated with cost compared to other demographic and clinical factors. Recipient MELD score is correlated with transplant costs without significantly impacting survival.

Adult↗
PubMed2007

High uptake of postpartum hormonal contraception among HIV-1-seropositive women in Kenya.

OBJECTIVES: The objectives of this study were to determine patterns of contraceptive utilization among sexually active HIV-1-seropositive women postpartum and to identify correlates of hormonal contraception uptake. GOAL: The goal of this study was to improve delivery of family planning services to HIV-1-infected women in resource-limited settings. STUDY DESIGN: HIV-1-infected pregnant women were followed prospectively in a perinatal HIV-1 transmission study. Participants were referred to local clinics for contraceptive counseling and management. RESULTS: Among 319 HIV-1-infected women, median time to sexual activity postpartum was 2 months and 231 (72%) women used hormonal contraception for at least 2 months during follow-up, initiating use at approximately 3 months postpartum (range, 1-11 months). Overall, 101 (44%) used DMPA, 71 (31%) oral contraception, and 59 (25%) switched methods during follow-up. Partner notification, infant mortality, and condom use were similar between those using and not using contraception. CONCLUSIONS: Using existing the healthcare infrastructure, it is possible to achieve high levels of postpartum hormonal contraceptive utilization among HIV-1-seropositive women.

Adolescent↗
PubMed2004

Dissemination of information on legislative mandates and consensus-based programs addressing payment of the costs of routine care in clinical trials through the World Wide Web.

BACKGROUND: Legislative and consensus-based programs that ensure payment for routine care costs in a trial have been enacted by a number of states and government-sponsored health benefits programs. To eliminate the potential for denial of payment by a health plan that can act as a barrier to participation, the public must be aware that these programs exist and what they entail. METHODS: World Wide Web sites are utilized by patients and their surrogates as a prime source of healthcare-related information. A review of cancer research organization and advocate group web sites was performed to document the degree to which these sites provided information on clinical trial coverage programs. The objective was to determine whether patients were being given sufficient information to overcome barriers to participation related to the existence of clinical trials, their potential benefits, and health plan payment. RESULTS: Fewer than 5% of the 373 sites reviewed provided sufficient information to communicate to a patient that 1) the institution participates in sponsored cancer clinical research, 2) patients can derive direct benefits by participating in a clinical trial, and 3) payment for treatment in a clinical trial is largely provided by their health plan. CONCLUSIONS: Sites on the World Wide Web are a key source of healthcare-related information for patients and their surrogates. Organizations involved in clinical cancer research should examine their web sites to ensure that the content it contains is sufficiently detailed, accessible, and readable to inform potential participants fully of the clinical trial options.

Clinical Trials as Topic↗
PubMed2005

Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women.

The upper limit of normal for ALT activity has been recommended to be lowered to < or = 30 U/L in men and < or = 19 U/L in women. These changes have been suggested to be diagnostically useful in subjects with nonalcoholic fatty liver disease (NAFLD). Our aim was to investigate the prevalence and spectrum of NAFLD with regard to the new ALT guidelines in 233 women with class II/III obesity. We compared our prior reference range for ALT (ULN < or = 30 U/L in women) with the new standard. Our study demonstrates that only 86 patients (36.9%) would be classified as having normal ALT levels compared with 169 patients (72.5%) by the new and old standards, respectively. In patients with normal ALT activity (new vs. old standard), the prevalence of fatty liver (FL: 39.5% vs 40.2%), portal fibrosis, and steatosis (IPF: 37.2% vs. 33.7%) and nonalcoholic steatohepatitis (NASH: 23.3% vs. 26%) were similar. In comparison, newly defined patients with elevated ALT levels (>19 U/L) demonstrated an increased prevalence of FL (36%) and IPF (11.6%) but a 23.8% decrease in the prevalence of NASH as compared with the old standard. The sensitivity and specificity for NASH were 42% and 80% (ALT > 30 U/L) compared with 74% and 42% (ALT > 19 U/L). In conclusion, a significant increase in the prevalence of FL and IPF is detected in subjects with elevated ALT levels with the application of the new standard. However, the diagnostic utility for ALT to identify NASH or IPF remains poor, and significant healthcare expenditures may be incurred if this standard is adopted.

Adult↗