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At least 1,243 records · Page 69Linked to original sources
PubMed1998

Managing utilization successfully in 12 not-so-easy steps.

Managing utilization involves managing the processes of care, which requires a system approach that coordinates services, eliminates redundancy in care delivery, and makes use of alternatives to traditional methods of meeting healthcare needs. On the caregiving level, internally developed benchmarks illuminate efficient or unneeded practice patterns, hospitalist programs help contain inpatient costs, and standard protocols and disease state management help to maintain expected measurable outcomes. Wisely managing patient access to care, relying upon case managers to oversee catastrophic care, assessing high-risk senior citizens and promoting their and other patients' relationships with social service agencies, and implementing patient education and prevention programs all can be coordinated within the managed care system.

Benchmarking↗
PubMed1975

A walking donor program for an intensive care nursery.

Repeated transfusions of small increments of blood are frequently required for the sick newborn infant to correct endogenous hypovolemia and/or to replace blood obtained repeatedly for monitoring purposes. Current practices of blood banks are rarely geared to supply the small amounts of blood used for these individual transfusions. To provide a more efficient system, a walking donor program was established in which an appropriate hospital-based individual is cross matched as a donor for an infant for the duration of the infant's hospital stay. The program eliminates wastage of blood and donors and reduces the number of infectious agents to which the infant may be exposed.

ABO Blood-Group System↗
PubMedDate not supplied

Report of a continuous quality improvement program in a tertiary-care medical center.

OBJECTIVE/DESIGN: Changes in the health system in Israel have led to an increasingly competitive environment, decentralization, and economic constraints. We evaluated the use of a continuous quality improvement (CQI) program. SETTING: Three medical departments and three administrative wings in a 700-bed, tertiary-care, teaching hospital in Jerusalem. INTERVENTION: The program was planned as a short-term pilot project for long-term extension throughout the institution. The objectives were improved institutional efficiency and provision for change. The program was implemented through departmental improvement teams under a hospital management team and a steering committee, guided by an outside consultant firm. RESULTS: The Orthopedics Department experienced a 3-day reduction in patient length of stay (P<.008). The Emergency Room experienced a significant reduction in time to discharge through reduced waiting times for consulting physicians (P<.007) and for blood tests (P<.001). The Office of Patient Admissions streamlined procedures for admission and discharge, accomplished physical restructuring, and installed a telephone hot line. In Medical Records, a significant improvement in records availability was realized. In Outpatient Clinics, reductions in waiting times were realized, but were not statistically significant. The Supply Division showed savings on monthly orders and increased efficiency, with 95% of orders completed promptly and accurately. CONCLUSIONS: Several factors were identified as essential to the success of the program, including staff cooperation and commitment. We conclude that the CQI program was a useful tool to help our tertiary-care medical center adjust to changes in the Israeli healthcare system. It also served as a valid vehicle for maintaining and furthering optimal quality of care.

Emergency Service, Hospital↗
PubMed1999

The role of the pediatrician in hearing loss. From detection to connection.

The advocacy by pediatricians is imperative if early hearing detection and intervention (EHDI) programs are to be effective, efficient, and successful over the long term. Some pediatricians remain unfamiliar with the rationale for universal screening of all newborns prior to hospital discharge. Pediatricians' questions regarding universal screening are data- and quality-driven. Discussion of the components of the EHDI program, answers to pediatricians' most frequently asked questions, supported by data, and the quality indicators used to monitor EHDI programs in Texas are provided.

Child↗
PubMedDate not supplied

Routine restaurant inspections and education of food handlers: recommendations based on critical appraisal of the literature and survey of Canadian jurisdictions on restaurant inspections and education of food handlers.

Inspection of restaurants and education of food handlers are two methods used by regulatory agencies to ensure food served in restaurants is safe to eat. The variation which exists in the implementation of these programs suggests that the programs' effectiveness is lacking or is not clear. Recommendations based on the Community Health Practice Guideline methodology, the results of a critical review of the literature, the results of a survey of practices, and expert opinion were developed. The recommendations include: continuation of routine inspections at a frequency of one to two inspections per year per restaurant and the continuation of education programs. The evidence on which these recommendations are based is scant and more research is needed to ensure programs are needed, effective and efficient.

Canada↗
PubMed1985

Evaluation of three cervical cancer detection programs in Japan with special reference to cost-benefit analysis.

Three screening programs for early cervical cancer currently in use in Japan were evaluated according to the following criteria: (1) economic effectiveness; (2) screening efficiency; and (3) access to medical care. The mobile program has the highest benefit-cost ratio (BCR, 1.20) and is hence most cost-effective; its detection rate, rescreening rate, and early cancer detection rate (proportion of Stage-O patients to all patients with cancer) are moderately high (0.09%, 2.07%, 55%, respectively). It is obviously suited to rural areas, especially where residents have a positive attitude toward local health services. The detection center program is less cost-effective than the mobile program (BCR, 0.83) but diagnostically the most effective with highest detection, rescreening, and early cancer detection rate (0.15%, 5.08%, 61%, respectively). It is suitable to large cities (population over 1 million) with efficient public transportation. The private physician program is economically and in terms of screening efficiency least effective of the three; its BCR being 0.40 and detection, rescreening, and early cancer detection rate being the lowest (0.08%, 0.29%, 33%, respectively). However, the private physician program is increasingly employed, presumably because of easy access to medical care, better rapport between the patient and physician, and, in addition, successful lobbying by private physicians.

Adult↗
PubMedDate not supplied

Efficiency and effectiveness: beyond internal practice operations.

Physician group practice management teams (physician-administrator teams) have had to become creative in developing efficient and effective practice operations as a result of managed care. For physicians that must use entities outside of the group to deliver care, these physicians must demand that these facilities provide a program that adheres to the principles of "operationally effective and efficient design (OEED)." Programs that comply with the six principles of OEED offer physicians the opportunity to maximize their monetary value of time. Programs that do not follow the OEED principles negatively impact the physicians' monetary value of time. As a result, physician-administrator teams must demand operations improvement from such entities, otherwise alternatives will be sought. Therefore, managed care may not be bad news for physicians.

Efficiency, Organizational↗
PubMed2003

Economic consequences of control programs for paratuberculosis in midsize dairy farms in the United States.

OBJECTIVE: To evaluate the epidemiologic efficacy and economic efficiency of current and potential future control programs for paratuberculosis (Johne's disease) on midsize dairy herds in the United States. DESIGN: Stochastic dynamic computer simulation model. SAMPLE POPULATION: Data on prices and other input variables collected from various sources were used to represent a population of midsize US dairy herds infected with paratuberculosis. PROCEDURE: The simulation model was modified to reflect management and production characteristics of midsize dairy herds in the United States. The model was validated by use of field data and expert opinion. Various control strategies then were simulated and compared on an epidemiologic basis and on the basis of economic efficiency. RESULTS: Test-and-cull strategies and vaccination against paratuberculosis were not able to decrease the mean prevalence of disease in the United States. Typically, only vaccination was economically attractive. Improved management strategies decreased the prevalence of paratuberculosis considerably and had high economic benefits. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of results of this study suggests that test-and-cull strategies alone do not reduce the prevalence of paratuberculosis in cattle and are costly for producers to pursue. Vaccination did not reduce the prevalence but was economically attractive. Finally, improved calf-hygiene strategies were found to be critically important in every paratuberculosis control program and most were economically attractive programs for midsize US dairy farms with the disease.

Animal Husbandry↗
PubMed1995

The impact of physician financial incentives on high-risk populations in managed care.

The challenge of managed care is to design a system in which rules and incentives together create a system of checks and balances that ensure both efficient and high-quality care. Incentives need to be administered so that physicians--both primary care providers and specialists--are not forced to choose between personal and/or organizational financial viability and patients' care. To accomplish this goal, payment needs to be linked both to quality and productivity and appropriately risk-adjusted. Quality assurance programs must ensure that both efficient and high-quality care is being provided and must maintain the satisfaction of both physicians and members. AIDS patients may be harmed by a system in which the more services a physician performs, the more he or she is paid--the traditional way in which American health care has been delivered heretofore. Managed care may undermine the care of high-risk patients if it arbitrarily reduces the high volume of care they require. However, a managed care system with effective checks and balances on financial incentives and quality of care can ensure that an efficient and high standard of care is being met--across all populations, including both healthy and high-risk patients.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Dynamic simulation of molecular and ionic materials.

Two new programs perform molecular dynamics simulations on molecular and ionic materials, respectively. The first simulates systems of small molecules, treated dynamically as rigid bodies, with interactions of the site-site Lennard-Jones form, plus point charges. The second simulates systems of point ions, which may be made polarizable by means of the shell model, treated by the method of adiabatic dynamics. Both programs handle Coulombic interactions in periodic boundaries by means of the Ewald sum. Force evaluations make use of efficient neighbor-search algorithms. The programs incorporate extensive analysis options in terms of structural and dynamic correlation functions. The programs are controlled by a command language, Dynamo, which provides a good environment for further development, as well as ease of use and flexibility in the choice of simulation protocol.

Algorithms↗
PubMed2000

Software program lets users test out capitation scenarios.

Want to figure out a profitable capitation rate? Need to know what else should be negotiated in a contract with a health plan besides compensation and how contract terms are used? The developers of CAP-MAN software say their program can do all that and more.

Capitation Fee↗
PubMed2001

[Computer-assisted acquisition and analysis of high-resolution spectrum].

Based on the unique characteristic of spectral line center in the whole spectrum and noise threshold, a computer approach and program for the determination of spectral line position and relative intensity automatically are presented in this paper. Exploring this approach and computer program, we pre-analyzed the partially overlapped 16 line TuFIR experiment spectra of CHF3. The results of line positions and intensities for these TuFIR spectra are in excellent agreement with the results by least-square fit with heavily manual inference. The accuracy and efficiency of this method and program will ensure their wide application in complex high-resolution molecular spectrum.

Algorithms↗
PubMed2006

Rapid response teams can help reduce mortality, 'code' rates.

Process gets help to patients further upstream, to detect signs of deterioration earlier. Takes about six months to begin to see real results from rapid response teams. Web site offers resources to quality managers interested in learning more about the program.

Critical Care↗
PubMed1989

OIG investigations and physicians' rights.

The Office of the Inspector General (OIG) was established to investigate the programs of the US Department of Health and Human Services (HHS). It recommends policy to promote economy and efficiency in the administration of HHS programs and also informs Congress about the problems and deficiencies of such programs (1). The President appoints the inspector general with the advice and consent of the Senate. While the inspector general is under the supervision of the secretary of HHS, he may be removed from office only by the President (2). The OIG's authority is wide ranging. It has a staff with specific responsibility for anti-fraud and abuse activities (3). The inspector general has access to all records that are available to HHS and which relate to programs the inspector general has the responsibility to police. It also may subpoena all records and evidence necessary for performance of its duties, which are enforceable by the order of any United States District Court (4). Of particular interest to physicians is the OIG's authority to take certain actions against physicians and against a hospital or other facility that has a contract to participate in Medicare or Medicaid.

Humans↗
PubMedDate not supplied

A cost analysis of family planning in Bangladesh.

This article presents a step-down cost analysis using secondary data sources from 26 Bangladesh non-government organizations (NGOs) providing family planning services under a US Agency for International Development-funded umbrella organization. The unit costs of the NGOs' Maternal-Child Health (MCH) clinics and community-based distribution (CBD) systems were calculated and found to be minimally different. Several simulations were conducted to investigate the impact of alternative cost-reduction measures. The more general financial analysis proved more insightful than the unit cost analysis in terms of identifying means by which to improve the efficiency of the family planning operations of these NGOs. The analysis revealed that 56 per cent of total expenditures in the two-tiered umbrella's organizational structure are incurred in management operations and overheads. Of the remaining 44 per cent of project expenditures, 39 per cent is spent on the CBD program and 5 per cent on the MCH clinics. Within the CBD program, most resources are spent providing 4 million contacts (two-thirds of the annual total) which do not involve contraceptive re-supply. The clinics devote more resources to providing MCH services than to providing family planning services. The findings suggest that significant savings could be generated by containing administrative costs, improving operational efficiency, and reducing unnecessary or redundant fieldworker contacts. The magnitude of the potential savings raises a fundamental question about the continued viability and sustainability of this supply-driven CBD strategy.

Adult↗
PubMedDate not supplied

[The national program for the early detection and treatment of premalignant and malignant diseases of the lower genital system in women].

Lower genital tract malignancies are often seen in our female population; their detection is often delayed and treatment fails frequently. Latest scientific data on their etiology and newer methods of their detection and treatment in the early stages opens roads in the field of primary and secondary prevention and for the effective therapy, as well. In order to improve current status of the women's health in this field, on October 10, 1995 year, the Section for cervical pathology and colposcopy in addition to Yugoslav Association of Gynecologists and Obstetricians (UGOJ), has been established. One of the most important aims of the Section is introduction of premalignant and malignant diseases of female lower genital tract. So far, the Section has: 1. Submitted the Program proposal to the Ministry of Health of Serbia; on the basis of that proposal, on April 10, 1996 year, the Ministry issued: "Expert instruction for the conduction of assignments aimed at early detection of the cancer of the uterine cervix". In that act obligatory for all health institutions, that have gynecology depts, all activities and goals for National Program introduction are prescribed. 2. The Yugoslav School for pathology of the cervix, vagina, vulva and colposcopy, opened in 1996, year, under the patronage of the Ministry of Health of the Republic Serbia provides the theoretical and practical training for the Program carriers and medical doctors receiving their training in gynecology and obstetrics. The first generation, the School attendees consisted of 149 doctors from the entire country. 3. Creation and submission of a draft common Health Form intended for the computerized and professional use, to provide for more efficient introduction of the National Program. The Form, should be introduced by the Health Ministry as an Official Health Document, to be used by all OBG institutions. 4. Submitted proposal of the activities and tasks in the field of Program realisation according to Health institutions' profiles. 5. Creation of the draft Protocol for actual activities and procedures in order to provide for an early detection and treatment of premalignant and malignant diseases of the female lower genital tract. Having the future mandatory character of this Protocol, the Section will divulge it to the professional audience. 6. Created a project of the National program and submitted it at the beginning of 1996 year, to the Republic Bureau of Health protection, with a request for its financial support in that program. In addition to the activities mentioned, the section management undertook and is taking measures for faster achievement of the aim-of the National Program introduction. Official Health institutions are assigned responsibilities of the Program introduction, the funding and a resolve all the legal, organisational and financial issues. Results that we are expected from this Program include introduction of the primary and secondary measures aimed at disease prevention; early detection of the diseases and its treatment; reduction of the numbers of cases in the advanced stages; significant improvement of gynecological status, and reduction of costs of the treatment of advanced stages of disease. The results should stimulate all, and become must for all subjects involved in the National Program realisation. The Program introduction into the daily OBG practice is a prerequisite of already well established practice in a number of countries, saving life and limb of most women affected by the lower genital tract malignancies.

Female↗
PubMed1997

A computerized radioactive material inventory system using a commercially available database program.

An accurate and current radioactive materials inventory is essential for efficient control and use of radioactive material. In order to facilitate data entry, a computerized radioactive material inventory procedure has been developed using a commercially available database program. This system allows inventory records to be entered and updated quickly and efficiently with desired reports generated, without needing extensive computer training or programming skills.

Documentation↗