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PubMed1984

National health insurance: a new imperative.

When viewed from the perspective of the policy analyst, observed inequities in the access to health services and the rising costs of physician and hospital care are among the most important issues confronting the American health delivery system. Recognizing that publicly financed health insurance programs result in a more equitable distribution of medical services, this paper focuses on the components of a national health insurance scheme that not only offers a comprehensive range of benefits but also employs prospective payment and a set of financial incentives to control the costs of care provided by physicians, hospitals, and other health facilities. The national health insurance program proposed in this paper is designed to eliminate or reduce unwarranted expenditures on plant and equipment; the responsibility for approving and funding capital acquisitions is also regarded as an integral component of the program.

Capital Expenditures↗
PubMed1992

Predominant pathogens in hospital infections.

To determine the distribution of pathogens causing nosocomial infections in United States hospitals, we analysed data from the National Nosocomial Infections Surveillance (NNIS) System. From October 1986 to December 1990, amongst hospitals conducting hospital-wide surveillance, the five most commonly reported pathogens were Escherichia coli (13.7%), Staphylococcus aureus (11.2%), enterococci (10.7%), Pseudomonas aeruginosa (10.1%), and coagulase-negative staphylococci (9.7%). The commonest pathogens reported by site included, bloodstream: coagulase-negative staphylococci, S. aureus, enterococci, E. coli, and Candida spp.; lower respiratory tract infection: S. aureus, P. aeruginosa and Enterobacter spp.; surgical wound infection: S. aureus, enterococci and coagulase-negative staphylococci; and urinary tract infection: E. coli, enterococci, and P. aeruginosa. Among hospitals conducting intensive care unit (ICU) surveillance, the commonest pathogens were P. aeruginosa (12.4%), S. aureus (12.3%), coagulase-negative staphylococci (10.2%), Candida spp. (10.1%), Enterobacter spp. and enterococci (8.6% each). In the ICUs, the commonest pathogens found in the bloodstream were coagulase-negative staphylococci, S. aureus, and enterococci; in lower respiratory tract infections P. aeruginosa, S. aureus, and enterococci; in surgical wound infections enterococci, coagulase-negative staphylococci, and Enterobacter spp. and in urinary tract infections Candida spp., E. coli, enterococci, P. aeruginosa, and Enterobacter spp. These data show that S. aureus, E. coli and P. aeruginosa remain important nosocomial pathogens, that coagulase-negative staphylococci, enterococci and C. albicans are pathogens of increasing importance, and that the distribution of pathogens differs by site and hospital location.

Adult↗
PubMed1989

PharmaTrend as a management tool: introduction.

Use of the PharmaTrend computerized management information system to document workload and productivity in hospital pharmacy departments is described. PharmaTrend provides indicators in the areas of revenue, cost, drug distribution, clinical services, research, education, and management support; examples are total direct cost per admission, total drug cost per drug distribution work unit, and comparisons between cost and revenue, supportive staff and pharmacist work hours, and total staff work and paid hours. The key information provided by PharmaTrend is not specific indicators or values, however, but the display of trends. PharmTrend files can be downloaded to other spreadsheet and database management programs; the sophisticated user can recalculate values for indicators or develop new indicators. Information about revenue and the cost of drug distribution is easily obtained from reports; this information, combined with data on hours worked to provide drug distribution services, can provide access to all the key PharmaTrend indicators. Institution-specific data are made available to managers elsewhere by submitting them for use in the PharmaTrend national report, which is organized so that users can compare values for their indicators with those reported by hospitals of various size in various geographic regions. PharmaTrend can be a valuable tool in hospital pharmacy management and provides a basis for developing accurate and meaningful workload standards for pharmacy practice.

Database Management Systems↗
PubMed2005

On the significance of reducing the need for stroke patients to visit the emergency department.

We studied the care-provider paths followed by 3,946 patients in Quebec in 2001. We showed that the patients flow during the three months preceding discharge from hospital can be represented by a Markov model with memory. This model enables study of four major scenarios to improve health outcomes, workloads and cost efficiency in the overall community-based care delivery system. Based on the field data, we establish that increasing the availability of specialists, family physicians and general practitioners to mitigate the need for ER visits would be an effective strategy for improvement. A comprehensive policy to support stroke patients needs to incorporate both hospital-based and community-based care delivery processes. The seamless flow of patients through the healthcare providers in such an integrated system is crucial for achieving successful outcomes. Emergency rooms (ER) have a crucial role in this context, since in many cases ER acts as the hospital's "gate keeper", determining if a patient needs to be (re)admitted. In this paper, we establish (based on field data) that mitigating the ER visits of stroke patients improves health outcomes, distribution of workload across the healthcare system as well as associated costs. To this end, we make use of a Markov modeling framework, where the aggregate patient flow information is represented in a compact form through the use of a transition-probability matrix. This allows us to investigate the system-wide impact of several plausible scenarios with regards to the delivery of community-based care to stroke patients who are recently discharged from hospital.

Community Health Centers↗
PubMed1990

A comparison of the effects of per case and per diem based charges on the distribution of hospital costs across employer groups.

In response to continuing health care cost increases, many employers have expressed interest in a case-mix hospital payment system. They believe that such a system will more accurately reflect their utilization of health care resources and assist them in better controlling their costs. Therefore, using data generated by the Experimental Hospital Case Mix Payment Program of Blue Cross of Western Pennsylvania, this paper compares employer group costs based on an average cost per diagnostic case with costs based on an average cost per day. The analysis shows that by changing the basis of employer group costs from the traditional per diem method to one based on diagnostic case, while some groups may benefit in the form of lower costs, many groups would experience substantial increases to their costs. In a model explaining differences in employer group costs between the two payment methods, patient diagnosis was found to be the major explanatory factor, contributing to two thirds of the total explained variation. In addition, results indicated that a group's total admissions, mean patient age and gender, and a hospital's teaching status, location, bed size, occupancy rate, and mean ancillary costs influence the differences in a group's costs under the two methods.

Age Factors↗
PubMed1999

Designing and implementing the transition to a fully digital hospital.

The increase in the number of examinations performed in modern healthcare institutions in conjunction with the range of imaging modalities available today have resulted in a tremendous increase in the number of medical images generated and has made the need for a dedicated system able to acquire, distribute, and store medical image data very attractive. Within the framework of the Hellenic R&D program, we have designed and implemented a picture archiving and communication system for a high-tech cardiosurgery hospital in Greece. The system is able to handle in a digital form images produced from ultrasound, X-ray angiography, gamma-camera, chest X-rays, as well as electrocardiogram signals. Based on the adoption of an open architecture highly relying on the DICOM standard, the system enables the smooth transition from the existing procedures to a fully digital operation mode and the integration of all existing medical equipment to the new central archiving system.

Hospital Administration↗
PubMed1987

Distributing and transferring medical technology. A view from Latin America and the Caribbean.

Great variation exists in the health care delivery systems throughout Latin America and the Caribbean. In general, medical technology is concentrated in large cities at private hospitals that serve a small, elite segment of the population. What is missing in most of these countries is a clearly defined social policy guaranteeing distribution of medical technology to all segments of society. While data is scarce, it appears that political and economic concerns, rather than medical concerns, determine what and how much technology will be available to all segments of the society. Products are sometimes imported that compete with domestically produced ones. Moreover, transfers of technology often fail to include the necessary knowledge to make imported technology truly useful. However, current economic crises throughout the region are forcing changes in policies; as a result, there is a new emphasis on domestic production of technology over imports and the evaluation of medical technology for its appropriate use in Latin America and the Caribbean.

Developing Countries↗
PubMed2000

[A study based on national DRG data to evaluate work load and practice relating to cancer patients in not-for-profit hospitals].

BACKGROUND: In France there is no reliable information describing the organisation of hospital care for patients with cancer. The present study attempts to clarify this issue taking advantage of an information source that has up to now been unused, namely the national PMSI (Information System Medical program) data base. METHODS: A quantitative study has been carried out regarding cancer management in France using information filed with the PMSI which compiles data related to hospital admissions in all institutions with more than 100 beds and subject to a defined global budget. The "cancer" component of hospital activity was extracted using a specific algorithm which utilized the diagnostic and intervention codes included in the admission summaries. By using the unit of activity as defined by the ISA (Activity Synthetic Index) and the scale of relative cost according to the GHM (Homogeneous Group of patients) it was possible to analyse the information in terms of a balance sheet. RESULTS: The study provided information regarding the costs and methods of management, including therapeutic strategies, for each type of hospital establishment. It is shown that with one death out of six, cancer covers a quarter of all hospital stays, and one sixth of annual hospital expenses. This accounts for 16.2% of ISA ie approximately 29 billion francs (4.6 billion dollars) for the public and semipublic sectors. Surgery, which accounted for 32% of expenditures, appeared to be the most expensive intervention, ahead of chemotherapy (16.3%) and radiotherapy (9.1%). Each type of hospital organisation (university, cancer centre, district hospital) had their own relative figures. CONCLUSION: Through this study the current situation regarding cancer care in hospital has been documented. It has also demonstrated the value of the PMSI data base as a source of information for large scale quantitative studies of health care economics. However, the PMSI does not yet provide details regarding infrastructure or succession of hospital stay. Ultimately, this analysis does not provide any information on the quality or efficacy of care but does define a typological system for health care organisations which could provide information on distribution of resources.

Costs and Cost Analysis↗
PubMedDate not supplied

[Vascular access in Spain: analysis of its distribution, morbidity, and monitoring systems].

Vascular access disfunction causes a therapeutic emergency with different implications in patients and care givers. The aim of this study was to know the distribution of different kinds of vascular access between prevalent hemodialysis patients, the proportion of incident patients that holds a permanent vascular access, the monthly hospital ratio for access repair and the use of surveillance systems of vascular access adequacy in the different Centers. This is a National survey that shows results of a questionnaire sent to all hemodialysis units in Spain on september 1999. Eighty-eight units answered the questionnaire (42%) providing information about 5,476 prevalent patients. Of these patients, 81% receives treatment through an arteriovenous fistula, 10% uses a central catheter and 9% a graft. Only 56% of incident patients have a permanent vascular access. Reasons for catheter use between prevalent patients were exhaustion of vascular sites in 42%, maduration of permanent access in 24%, thrombosis of the access in 14% and another reasons in 19%. Patients monthly hospitalization ratio for vascular repair was 3%, that might represent more than 5,600 hospital ingress by year. More than 80% of the Units releases different surveillance programs of access adequacy, 69% by fiscal detection problems, 47% by dynamic alterations and 18% by dilution and imaging procediments. The conclusions of this survey are that arteriovenous fistula is the most used vascular access in Spain. Almost half of the patients do not have vascular access in use for the beginning of hemodialysis. Exhausted vascular sites is the primary reason for central catheter using. A great proportion of Units are employing programs for access monitoring.

Catheters, Indwelling↗
PubMed1996

Clinical experiences with computed radiography.

Computed radiography (CR) based on photostimulable phosphor is currently the only feasible way for a radiological department to digitize the bulk of radiological data: the lung and skeletal examinations. Regarding the quality of images for diagnostic purposes, CR imaging is never inferior to a screen/film system (SF) and for several clinical entities CR is superior. Of the many processing possibilities of the image plate (IP) image, the unsharp masking or edge enhancement should be used at a minimum. Dose reduction with CR ranges from 15% to 95%; at our institution it is 37%. Softcopy reading of CR images is advantageous due to the many postprocessing and improved display facilities. Currently there is little use for a 4000 x 4000 (4 K) pixel imaging and display. All images (including mammography) can be read in 2 K without any loss of clinically important information. To include CR in a picture archive and communication system (PACS) is demanding because of the load of data that each CR image represents. Networks for image distribution are essential if digital imaging is to have any impact on patient treatment and hospital organization.

Bone and Bones↗