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PubMed2000

The burden of cancer in Kentucky. The 1998 Kentucky cancer incidence report.

The purpose of collecting this important disease burden information is just for reports like this. The real value lies in use of data for cancer control research, program planning, resource allocation, program design, and evaluation. Data in the annual KCR report and on the website should be a valuable resource for health agencies, clinicians, policymakers, voluntary organizations, etc in their assessment of health problems in their area and as critical decisions are made about how to utilize limited intervention resources. The Kentucky Cancer Registry will continue to work very closely with the Kentucky Cancer Program, Kentucky Medical Association, and programs and research efforts at the University of Kentucky Cancer Control Program (Mid South Cancer Information Service, Appalachia Cancer Network, Kentucky Prevention Research Center) and the Brown Cancer Center at the University of Louisville to make these data available to partners throughout the Commonwealth to help guide their assessment and planning processes. If you have questions about this data you are encouraged to contact Regional Coordinators for the Kentucky Cancer Program in your Area Development District. The contact information is shown in Appendix I.

Adolescent↗
PubMed1995

Measuring the cost-effectiveness of cancer care.

Historically, new therapeutic strategies for cancer have been evaluated on the basis of safety and clinical efficacy. However, the current national emphasis on efficiency of resource allocation has led to the inclusion of economic assessments in oncology studies. Economic assessments measure patients' health status and resource consumption associated with a therapeutic strategy, and combine these in a cost-effectiveness analysis. Study design can include prospective analysis of clinical trials, retrospective analysis of a clinical trial or administrative databases, or a decision analytic model. Economic analysis is being used increasingly in oncology and will continue to provide meaningful data to assist clinicians in determining the optimal treatment strategies for cancer patients and to help inform health policy decision-makers about the importance of specific cancer therapeutic strategies.

Cost-Benefit Analysis↗
PubMedDate not supplied

Mass screening models for contagious diseases with no latent period.

In this paper, a simplified model describing the stochastic process underlying the etiology of contagious and noncontagious diseases with mass screening is developed. Typical examples might include screening of tuberculosis in urban ghetto areas, venereal diseases in the sexually active, or AIDS in high risk population groups. The model is addressed to diseases which have zero or negligible latent periods. In the model, it is assumed that the reliabilities of the screening tests are constant, and independent of how long the population unit has the disease. Both tests with perfect and imperfect reliabilities are considered. It is shown that most of the results of a 1978 study by W.P. Pierskalla and J.A. Voelker for noncontagious diseases can be generalized for contagious diseases. A mathematical program for computing the optimal test choice and screening periods is presented. It is shown that the optimal screening schedule is equally spaced for tests with perfect reliability. Other properties relating to the managerial problems of screening frequencies, test selection, and resource allocation are also presented.

Communicable Diseases↗
PubMed2006

State-level variations in income-related inequality in health and health achievement in the US.

The objective of this study was to examine state-level variations in income-related inequality in health and overall health achievement in the US. Data that were representative of the US and each state in 2001 were extracted from the Current Population Survey 2001. Income-related inequality in health and health achievement were measured by Health Concentration and Health Achievement Indices, respectively. Significant variations were found across states in income-related inequality in health and health achievement. In particular, states in the south and east regions, on average, experienced a higher degree of health inequality and lower health achievement. About 80% of the state-level variation in health achievement could be explained by demographics, economic structure and performance, and state and local government spending and burden. In contrast, medical care resource indicators were not found to contribute to health achievement in states. States with better health achievement were more urbanized, had lower proportions of minority groups, females and the elderly, fewer individuals below the poverty line, larger primary industry, and lower unemployment rates. Also, per capita state and local government spending, particularly the proportion spent on public health, was positively associated with better health achievement. Because of the direct implications of health level and distribution in resource allocation and social norms, states with a lower level of health achievement need to prioritize efforts in increasing and reallocating resources to diminish health inequality and to improve population health.

Financing, Government↗
PubMed1994

Working memory and inference revision in brain-damaged and normally aging adults.

This study examined the association between estimated working memory (WM) capacity and comprehension of passages that required revision of an initial interpretation. Predictions stemmed from the recently elaborated theory of capacity-constrained comprehension (Just & Carpenter, 1992, Psychological Review, 99, 122-149), which includes as a major feature the principle that WM influences comprehension only as processing demands approach or exceed the limits of capacity. As anticipated from task analysis, correlations between unilaterally brain-damaged patients' estimated WM capacity and discourse comprehension performance were minimal for nondemanding measures, and increased in magnitude with task processing requirements. Most notably, a meaningful correlation (/r/ greater than .50) emerged only for the task judged to involve the most demanding comprehension processes, for adults with right hemisphere brain damage. No meaningful associations between estimated WM capacity and task performance were observed for normally aging subjects, who were not expected to have difficulty with any of our comprehension measures. The nature of WM deficits in brain-damaged adults (total capacity, vs. resource allocation, vs. slow or otherwise faulty component processing operations) is considered, and some existing work is interpreted from a cognitive resource perspective. Theoretical implications and clinical applicability of the working memory/resource framework are also discussed.

Aged↗
PubMed2006

Prevalence of immune thrombocytopenia: analyses of administrative data.

BACKGROUND: The prevalence of immune thrombocytopenic purpura (ITP) in the USA is unknown. The paucity of data makes clinical trial design and resource allocation challenging. OBJECTIVES: We aimed to quantify the prevalence of ITP in one state and to report on utilization of resources. METHODS: The Maryland Health Care Commission supplied utilization data on all privately insured Maryland residents in 2002. We identified patients having two claims, separated by at least 30 days, for International Classification of Diseases, Ninth Revision, Clinical Modification code 287.3 (expected to be predominantly ITP). We excluded patients with concurrent diagnoses that made ITP unlikely. In sensitivity analyses, we varied the required visit interval between 14 and 180 days. We quantified ITP prevalence, resource utilization, and prevalence of concurrent autoimmune illnesses. RESULTS: The age-adjusted prevalence of ITP was 9.5 per 100,000 persons (10.5 per 100,000 when requiring a minimum 14-day interval and 4.5 per 100,000 with a 180-day interval). There was a predominance of males in childhood and of females in the middle-adult years, with an overall prevalence rate ratio of 1.9 for females to males. Twenty per cent of these patients were hospitalized, but emergency department use was rare, as was splenectomy. A concurrent diagnosis of multiple sclerosis was 25 times more prevalent than anticipated. CONCLUSIONS: We conclude that the prevalence of ITP in one populous state in the USA is comparable with that which has been reported in Europe. The suggested co-occurrence of ITP and multiple sclerosis in children merits further investigation.

Adolescent↗
PubMed1994

Rationale for cost-effective laboratory medicine.

There is virtually universal consensus that the health care system in the United States is too expensive and that costs need to be limited. Similar to health care costs in general, clinical laboratory expenditures have increased rapidly as a result of increased utilization and inflationary trends within the national economy. Economic constraints require that a compromise be reached between individual welfare and limited societal resources. Public pressure and changing health care needs have precipitated both subtle and radical laboratory changes to more effectively use allocated resources. Responsibility for excessive laboratory use can be assigned primarily to the following four groups: practicing physicians, physicians in training, patients, and the clinical laboratory. The strategies to contain escalating health care costs have ranged from individualized physician education programs to government intervention. Laboratories have responded to the fiscal restraints imposed by prospective payment systems by attempting to reduce operational costs without adversely impacting quality. Although cost containment directed at misutilization and overutilization of existing services has conserved resources, to date, an effective cost control mechanism has yet to be identified and successfully implemented on a grand enough scale to significantly impact health care expenditures in the United States.

Clinical Laboratory Techniques↗
PubMed1995

The relationship between hospital charges and a modified Parsonnet risk score.

Health care now consumes approximately 14 percent of the U.S. Gross National Product (GNP). The amount of money spent on health care in America per capita and as a percentage of GNP far exceeds that of any other industrialized country. Currently, the financial burden of health care is being shouldered by government and business. The expenditure of billions of dollars of corporate profits on health care progressively undermines the global competitiveness of American business. These economic realities have emerged as the dominant driving force in health care reform. Cost control efforts to date have focused on strategies to limit inpatient hospital expenditures. The DRG prospective payment system is designed to reimburse a fixed sum based on the diagnostic category of the patient. The DRG payment is essentially independent of underlying patient characteristics that can potentially drive up expenditures. The work reported in this article was done to develop a descriptive formula that could be used to predict resource consumption in the care of patients. The financial viability of a hospital depends on its ability to predict expenditures, allocate resources, and choose its service areas correctly. Errors in financial forecasting in the era of prospective payment will result in financial failures of entire institutions.

Age Factors↗
PubMed2002

Mission aligned management and allocation: a successfully implemented model of mission-based budgeting.

In response to declining funding support and increasing competition, medical schools have developed financial management models to assure that resource allocation supports core mission-related activities. The authors describe the development and implementation of such a model at the University of Wisconsin Medical School. The development occurred in three phases and included consensus building on the need for mission-based budgeting, extensive faculty involvement to create a credible model, and decisions about basic principles for the model. While each school may encounter different constraints and opportunities, the authors outline a series of generic issues that any medical school is likely to face when implementing a mission-based budgeting model. These issues include decisions about the amounts and sources of funds to be used in the budgeting process, whether funds should be allocated at the department or individual faculty level, the specific metrics for measuring academic activities, the relative amounts for research and teaching activities, and how to use the budget process to support new initiatives and strategic priorities. The University of Wisconsin Medical School's Mission Aligned Management and Allocation (MAMA) model was implemented in 1999. The authors discuss implementation issues, including timetable, formulas used to cap budget changes among departments during phase-in, outcome measures used to monitor the effect of the new budget model, and a process for school-wide budget oversight. Finally, they discuss outcomes tracked during two years of full implementation to assess the success of the new MAMA budget process.

Budgets↗
PubMed2002

Morality and the limits of societal values in health care allocation.

In this paper, we consider whether there is a clear moral justification for the proposal that societal value preferences (SVPs) should be included in Cost Effectiveness Analyses (CEA) of health care resource allocations. We argue, first, that proponents of the use of SVPs need to be clear about the relationship between these values and moral principles. In particular, once moral principles are accepted as ruling out some SVPs (such as those that are irrational or revealing prejudice), an account is required of why we need to appeal to SVPs rather than moral principles to determine a just division of health care resources. Secondly, we consider whether an independent moral justification might underwrite the use of SVPs. In various places in the literature the notions of representation, presumed consent and democratic decision making appear to be invoked as candidates for fulfilling this justificatory role. We discuss some problems with each of these justifications in the hope of eliciting a more comprehensive proposal from the proponents of SVPs. We conclude that, although a number of interesting proposals have been made, no compelling justification for including SVPs in CEA has yet been systematically articulated.

Community Participation↗
PubMed2004

Application of decision analysis to forest road deactivation in unstable terrain.

Resource managers require objective methodologies to optimize decisions related to forest road deactivation and other aspects of road management, especially in steep terrain, where road-related slope failures inflict extensive environmental damage. Decision analysis represents a systematic framework that clearly identifies real options and critical decision points. This framework links current decisions with expected future outcomes and provides advantages such as a common currency to systematically explore the liability consequences of limited budget expenditures to road deactivation and other road-related activities. Furthermore, the decision framework prevents the analysis from becoming hopelessly entangled by the vast number of possibilities generated by the alternative occurrences, magnitudes, and consequences of landslide/debris flow events and provides the information required for the first step of an adaptive management process. Here, a structured analysis of potential environmental risks for a road deactivation project in coastal British Columbia, Canada is presented. The application of decision analysis generates a ranking of the expected benefits of proposed deactivation activities on various road sections. The ranking distinguishes between road sections that offer high expected benefit from those that offer moderate to low expected benefit. Seventeen of 171, 100-m road segments accounted for 18% of the cumulative cost and 98% of the cumulative expected net benefits from road deactivation. Furthermore, the cost of deactivating a section of road is related to the expected benefit from such deactivation, thus providing the basis for more effective resource allocation and budgeting decisions.

Conservation of Natural Resources↗
PubMed2000

Accelerated age-related decline in processing resources in schizophrenia: evidence from pupillary responses recorded during the span of apprehension task.

Cognitive impairment in schizophrenia may be related to reduced availability of information-processing resources (resource limitations hypothesis). An abnormally accelerated age-related decline in processing resource availability may also occur in older patients with schizophrenia (neurodegeneration hypothesis). To test these hypotheses, pupillary responses were recorded as an index of processing resource availability during performance of the span of apprehension (SOA) task in 33 middle-aged and older patients with schizophrenia and 37 age-comparable nonpsychiatric participants. Consistent with the resource-limitations hypothesis, the patients with schizophrenia showed impaired detection accuracy and abnormally small pupillary responses (reduced resource allocation) only in the higher processing load SOA conditions. This pattern of results suggests that the patients depleted their available processing resources at lower processing loads than the nonpsychiatric participants. Consistent with the neurodegeneration hypothesis, cross-sectional analyses showed abnormally accelerated rates of age-related decline in SOA performance and pupillary responses in the patients with schizophrenia relative to age-comparable normal participants.

Age Factors↗
PubMed2001

"There is power in the blood": a case discussing ethical issues of utility of resources.

The allocation of medical resources is often a great concern in the United States. This article discusses a case concerning utility of resources in a patient with a terminal disease. We assert that the goals of treatment tailored to an individual patient should be made at the bedside by a fiduciary (physician) in conjunction with the patient's preferences and values. There is great responsibility in making these decisions and it is critical that they be made at the bedside with the patient and family clearly aware of the goals of treatments and informed of treatment limitations.

Adenocarcinoma↗
PubMed2004

Queuing theory accurately models the need for critical care resources.

BACKGROUND: Allocation of scarce resources presents an increasing challenge to hospital administrators and health policy makers. Intensive care units can present bottlenecks within busy hospitals, but their expansion is costly and difficult to gauge. Although mathematical tools have been suggested for determining the proper number of intensive care beds necessary to serve a given demand, the performance of such models has not been prospectively evaluated over significant periods. METHODS: The authors prospectively collected 2 years' admission, discharge, and turn-away data in a busy, urban intensive care unit. Using queuing theory, they then constructed a mathematical model of patient flow, compared predictions from the model to observed performance of the unit, and explored the sensitivity of the model to changes in unit size. RESULTS: The queuing model proved to be very accurate, with predicted admission turn-away rates correlating highly with those actually observed (correlation coefficient = 0.89). The model was useful in predicting both monthly responsiveness to changing demand (mean monthly difference between observed and predicted values, 0.4+/-2.3%; range, 0-13%) and the overall 2-yr turn-away rate for the unit (21%vs. 22%). Both in practice and in simulation, turn-away rates increased exponentially when utilization exceeded 80-85%. Sensitivity analysis using the model revealed rapid and severe degradation of system performance with even the small changes in bed availability that might result from sudden staffing shortages or admission of patients with very long stays. CONCLUSIONS: The stochastic nature of patient flow may falsely lead health planners to underestimate resource needs in busy intensive care units. Although the nature of arrivals for intensive care deserves further study, when demand is random, queuing theory provides an accurate means of determining the appropriate supply of beds.

Critical Care↗
PubMed2006

Can non-directional male mating preferences facilitate honest female ornamentation?

Recent studies have demonstrated male mate choice for female ornaments in species without sex-role reversal. Despite these empirical findings, little is known about the adaptive dynamics of female signalling, in particular the evolution of male mating preferences. The evolution of traits that signal mate quality is more complex in females than in males because females usually provide the bulk of resources for the developing offspring. Here, we investigate the evolution of male mating preferences using a mathematical model which: (i) specifically accounts for the fact that females must trade-off resources invested in ornaments with reproduction; and (ii) allows male mating preferences to evolve a non-directional shape. The optimal adaptive strategy for males is to develop stabilizing mating preferences for female display traits to avoid females that either invests too many or too few resources in ornamentation. However, the evolutionary stability of this prediction is dependent upon the level of error made by females when allocating resources to either signal or fecundity.

Animals↗
PubMed1995

Autonomic indicators of information processing related to conditioning.

The aim of the present study was to quantitatively investigate the role of information processing in conditioning using stimuli with varying amounts of information content. A letter reproduction task varying in complexity served as the unconditioned stimulus. In the first experiment, we tested the indicator function of electrodermal and cardiovascular variables. The amount of information processing resources required emerged most clearly in electrodermal reactions (EDRs), showing an increase with increasing stimulus information content. A second experiment was performed using the same design to confirm the role of processing resources allocation during conditioning by means of an independent indicator. A reaction time task was introduced as a measure of information processing resources utilized. The results paralleled the dependence of EDRs on stimulus information content, as was found in the first experiment.

Adult↗
PubMed1988

Current policy issues in the Irish Health Services.

The article provides a general outline of current policy issues in the Irish health services. Referring to a demographic and epidemiological background and taking into account the recent trends in health expenditure, the author deals with six main issues: selection and clarification of objectives, funding, resource allocation, organisation, managing for change, the public/private mix. Comparing Ireland to other European countries, the author concludes that, because of limited resources, Ireland must be clearer and cleverer. The meeting of the expectations of the population will continue to provide a stirring challenge.

Demography↗
PubMed1999

The role of the intensive care unit in the management of the critically ill surgical patient.

Surgical patients make up 60-70% of the work load of intensive care units in the UK. There is a recognised short fall in the resource allocation for high dependency units (HDUs) and intensive care units (ICUs) in this country, despite repeated national audits urging that this resource be increased. British ICUs admit patients later and with higher severity of illness scores than elsewhere and this leads to higher ICU mortality. How can this situation be improved? Scoring systems that allow selection of appropriate patients for admission to ICU and avoid inappropriate admission are still in development. Pre-operative admission and optimisation in ICU is rare in this country despite increasing evidence to support this practice in high risk surgical patients. Early admission to ICU, with potential improvement in outcomes, could also be achieved using multi-disciplinary medical emergency teams. These teams would be alerted by ward staff in response to set specific conditions and physiological criteria. These proposals are still under trial but may offer benefit by reducing mortality in critically ill surgical patients.

Critical Illness↗