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PubMed2001

[Minor head injury management in Spain: a multicenter national survey].

INTRODUCTION AND OBJECTIVES: Despite of the high incidence of minor head injury, there is still controversy and disparity of criteria regarding its management. The lack of consensual protocols and clinical guidelines can lead to deficiencies in the attention to these patients and to inadequate use of resources. The objective of this study has been to describe the present situation of the management of this entity in the neurosurgical departments of the Spanish public hospitals, and to compare it with other European countries. MATERIAL AND METHODS: A 57-item questionnaire regarding different aspects of minor head injury was designed and distributed to the 66 neurosurgical departments of the Spanish National Health System between December 1999 and February 2000. RESULTS: A 83.3% of responses were obtained. More than 92,000 patients per year are assisted at the Spanish third-level hospitals (general hospitals) after suffering a minor head injury. In-hospital on duty neurosurgeons are not available in 49.1% of the Spanish neurosurgical departments. Only in 7.3% of the centres the neurosurgeon is the first physician that assists these patients. However, in 52.7% of the hospitals neurosurgical evaluation is required if the patient refers transient loss of consciousness. A GCS score of 13 is still included in the group of minor head injuries in 29.1% of the centres. Although 89.1% of the surveyed neurosurgical departments considered as satisfactory the attention they provide to these patients, 85.5% think that it would be convenient to elaborate clinical guidelines. Cranial x-ray is considered a useful diagnostic tool by only 38.2% of the centres, however, 89.1% of them still use it as a routine. CT-scan is systematically indicated in all patients after suffering a mild head trauma only in 5.5% of the centres, although it is completely available in 74.5% of them. The study of economical costs shows that choosing cranial CT as screening tool in these patients would mean a 40.6% reduction in costs compared to a management based on x-ray plus in-hospital observation. CONCLUSIONS: This study shows the inter-hospital variability of minor head injury management in Spain. Clinical guidelines are considered as positive and necessary. Although the Spanish situation is similar to that in other European countries, following the tendency toward a broader cranial CT utilisation, would improve diagnosis profitability and economical efficiency. The results of this study may contribute to the creation of consensual protocols and clinical guidelines in our country that help in daily practice decision-making optimising assistance quality.

Adult↗
PubMedDate not supplied

A computerized system to improve documentation and reporting of pharmacists' clinical interventions, cost savings, and workload activities.

A major factor in delivering patient care is documenting activities by pharmacists. This documentation is not only essential to sustain existing programs but necessary to justify future growth of resources. A computerized documentation system for clinical interventions and workload activities was developed in a 340-bed university teaching hospital. With the expansion of its pharmaceutical care model, the department reworked its distribution process to allocate more pharmacist time for patient care. Manual documentation of these services, however, soon was identified as an obstacle. A software program was developed to alleviate the problems inherent with manual documentation. This "user-friendly" program tracks clinical recommendations and interventions by pharmacists, and calculates cost savings/avoidance. It also facilitates monthly and annual reporting for department managers.

Clinical Pharmacy Information Systems↗
PubMed2005

[An evaluation of costs in nephrology by means of analytical accounting system].

BACKGROUND: The analytical accounting is a countable technique directed to the evaluation, by means of pre-established criteria of distribution, of the internal economy of the hospital, in order to know the effectiveness and efficiency of Clinical Units. The aim of this study was to analyze the activity and costs of the Nephrology Department of General Hospital of Castellón. METHODS: Activity of Hospitalization and Ambulatory Care, during 2003 was analysed. Hospitalization discharges were grouped in DGR and the costs per DGR were determinated. RESULTS: Total costs Hospitalisation and Ambulatory Care were 560.434,9 and 146.317,8 Euros, respectively. And the costs of one stay, one first outpatient visit and maintenance visit were 200, 63, and 31,6 Euros, respectively. Eighty per cent of the discharges were grouped in 9 DGR and DRG number 316 (Renal Failure) represented 30% of the total productivity. Costs of DGR 316 were 3.178,2 Euros and 16% represented laboratory cost and costs of diagnostic or therapeutic procedures. CONCLUSION: With introduction of analytical accounting and DGR system, the Nephrology Departments can acquire more full information on the results and costs of treatment. These techniques permits to improve the financial and economic performance.

Accounting↗
PubMed1991

PMCs--an alternative to DRGs for trauma care reimbursement.

Payments made for inpatient trauma care were compared using two different patient classification systems--Patient Management Categories (PMCs) and Diagnosis Related Groups (DRGs). Two databases were used in this study: 1) estimated costs for all inpatient claims from one large payor for adult injured patients (n = 5,256) treated at 79 acute care facilities (trauma centers and non-trauma centers) in one geographic region; and 2) hospital charges from statewide, all-payor Maryland data, including 25,987 adult injured patients. The accuracy of PMCs and DRGs in predicting actual costs was examined by level of injury severity and by types of hospital, trauma center vs. non-trauma center. Level of injury (minor, single significant, multiple significant, and major) were defined and operationalized using PMCs. Overall, both DRG and PMC payment systems were nearly equal to the actual costs associated with all injured patients. This relationship can be designed into the weighting scale used for payment. The distribution of DRG payments by injury severity level, however, is not reflective of the differential resources required to manage each patient type. In particular, multiple injuries and major injuries that require the specialized services of a trauma center were inaccurately categorized by DRGs and systematically underpaid by 21.0% to 39.0% by DRG payment. By contrast, the Patient Management Category System classifies patients into more clinically specific and accurate categories and offers a more equitable method of distributing payments by injury severity. These same relationships were also found at the hospital level, demonstrating the potential for use of PMCs as an equitable and viable alternative.

Costs and Cost Analysis↗
PubMed1984

[Genetic polymorphism and rare variants of alpha 1-antitrypsin in the population of Moscow. Research using isoelectric focusing on an ultrathin gel].

The data are presented on distribution of subtypes and rare variants of Pi system for Moscow population. Serum samples were obtained from 210 families of healthy newborn (father-mother-newborn) from several Moscow maternity hospitals. Phenotypes of alpha 1-antitrypsin were detected by isoelectric focusing in ultrathin layer polyacrylamide gel with the range 3.5-6. In this study 5 common PiM subtypes (except M3M3) were found. The observed distribution of Pi subtypes shows a good agreement with the Hardi-Weinberg equation. The gene frequencies of the subtypes estimated for Moscow population were as follows: PiM1-0.7662, PiM2-0.1779, PiM3-0.0398. They did not show any difference from the corresponding frequencies in other European populations. In the course of our studies, some rare phenotypes, such as MS, MZ, FM and IM that were observed in most European populations, were detected. Furthermore, a very rare variant (MT) which had been only once revealed in European population, was found. The total gene frequency of all rare variants was 0.0162.

Adult↗
PubMed1975

Prognosis and treatment of Wilms' tumor at Great Ormond Street Hospital for Sick Children--1960-1972.

Eighty-one children with a diagnosis of Wilms' tumor who were treated at the Great Ormond Street Hospital for Sick Children between 1960 and 1972 are reviewed. The National Wilms' Tumor Study group staging system is used. Distribution by age and sex in each stage together with survival rate is given. Treatment and prognostic factors are discussed. Wilms' tumor is most common in children below the age of 3 years. There was a survival rate of 87% in Stage I, 36% in Stage II, 8% in Stage III, and 33% in Stage IV. The survival was worse in patients with locally advanced tumor than in patients who had pulmonary metastases in association with a locally resectable tumor. Whole abdominal irradiation is necessary in all patients in whom the tumor has breached the renal capsule. Single agent chemotherapy has not proved effective in preventing relapse in patients with advanced tumors. More intensive therapy is needed in this group to prevent both local recurrence and distant metastases. The addition of multiple drug chemotherapy to nephrectomy and whole abdominal irradiation is already improving the disease-free survival.

Adolescent↗
PubMed2002

A humanist's legacy in medical informatics: visions and accomplishments of Professor Jean-Raoul Scherrer.

OBJECTIVE: To report about the work of Prof. Jean-Raoul Scherrer, and show how his humanist vision, his medical skills and his scientific background have enabled and shaped the development of medical informatics over the last 30 years. RESULTS: Starting with the mainframe-based patient-centered hospital information system DIOGENE in the 70s, Prof. Scherrer developed, implemented and evolved innovative concepts of man-machine interfaces, distributed and federated environments, leading the way with information systems that obstinately focused on the support of care providers and patients. Through a rigorous design of terminologies and ontologies, the DIOGENE data would then serve as a basis for the development of clinical research, data mining, and lead to innovative natural language processing techniques. In parallel, Prof. Scherrer supported the development of medical image management, ranging from a distributed picture archiving and communication systems (PACS) to molecular imaging of protein electrophoreses. Recognizing the need for improving the quality and trustworthiness of medical information on the Web, Prof. Scherrer created the Health-On-the-Net (HON) foundation. CONCLUSIONS: These achievements, made possible thanks to his visionary mind, deep humanism, creativity, generosity and determination, have made of Prof. Scherrer a true pioneer and leader of the human-centered, patient-oriented application of information technology for improving healthcare.

History, 20th Century↗
PubMed2005

[Controlling retests in a universal hearing screening program].

INTRODUCTION: To evaluate the influence of several factors in the need for retesting in the first stage of a universal auditory screening program, a prospective and statistic study is presented, specially remarking the differences found between two health systems (public and private). PATIENTS AND METHODS: 18,073 children born in the 1999-2004 period were included in the study, in the context of a universal screening protocol based on Otoacoustic emissions and ABR, and distributed into three groups depending on their place of birth (A: public hospital; B: private hospital; C: children from other region). RESULTS: Significant differences were found between the groups (7.3% retesting in the public system and 2.4% in the private), explained by the fact that in the first group the test was performed in 74.9% of cases within 3 days after birth (when the need for repetition was 7,7%), and in the other groups the exploration was delayed up to 4-10 days in most cases (when retesting was performed only in 4.9%). DISCUSSION AND CONCLUSIONS: Proportion of retesting in the first stage of a universal screening program is an important factor for the cost estimation of these protocols. We assume that the age at testing varies significantly this factor, and on the contrary, we know that precocious exploration (before the child leaves the hospital) increases the program covering. Therefore we conclude that the test should be delayed only in health systems needing to save resources or not able to test before discharge, and not in those wanting to guarantee the maximum covering.

Female↗
PubMed1987

A model to determine staff levels, cost, and productivity of hospital units.

A methodology is presented with examples of the productivity, the staffing required, the resultant productivity, and costs that can be obtained for hospital units that are subject to random work demands such as laboratory, radiology, physical therapy, and nuclear medicine. The methodology assumes that the hospital has a labor productivity system that produces the RVUs or earned hours of work accomplished daily by shift. Factors considered are the distribution of the capabilities of the work force, the fatigue and delay allowances of the work standards, the quality of the work standards, the maximum amount of overtime that people will be asked to work, staffing policies such as constant or different staffing levels for each day of the week, and worker selection processes. Predicted results are compared with present practice, which indicates that substantial cost reductions can occur with the use of the methodology.

Budgets↗
PubMed1987

Providing financial justification to support a stand-alone computer system in a large tertiary-care hospital.

An assessment of the pharmacy's needs and an evaluation of the pharmacy's batch-oriented data processing system supported the acquisition of a new computer system to meet the pharmacy's requirements in the areas of: Medication order entry Response time Capability to interface a materials management system Capability to interface to a patient billing program Development of an audit trail for patient charges Management reports Flexibility for future needs Conversion from a dated batch-oriented system to a medication on-line computerization system has provided enhanced benefits in the areas of fiscal accountability, inventory management, improved quality of pharmaceutical services (drug distribution and drug therapy monitoring), and employee productivity.

Capital Expenditures↗
PubMed2000

Resource distribution in mental health services: changes in geographic location and use of personnel in Norwegian mental health services 1979-1994.

BACKGROUND: During the last decades, a central aim of Norwegian health policy has been to achieve a more equal geographical distribution of services. Of special interest is the 1980 financial reform. Central government reimbursements for the treatment of in-patients were replaced by a block grant to each county, based on indicators of relative "need". AIMS OF THE STUDY: The aim of this paper is to assess whether the distribution of specialized mental health services did take the course suggested by the proponents of the reform (i.e. a more equal distribution), or the opposite (i.e. a more unequal distribution) as claimed by the opponents. METHODS: Man year per capita ratios were used as indicators for the distribution of mental health services by county. Ratios were estimated for "all personnel", and for MDs and psychologists separately. Man years were assigned to counties by location of services (i.e. in which county the services were produced), and by residence of users (i.e. in which county the services were consumed). Indicators of geographic variation were estimated using the standard deviation (STD) as a measure of absolute variation, and the coefficient of variation (CV) and the Gini index as indicators of relative variation. Indicators were estimated for 1979, 1984, 1989 and 1994, based on data for all specialized adult mental health services in the country. Changes in distributions over the period were tested, using Levene's test of homogeneity. RESULTS: Relative variations in the distribution of personnel by location of services were substantially reduced over the period, the CV being reduced by more than 50% for all groups. Variations in the personnel ratios by residence of users were smaller at the start of the period, and the reductions were also smaller. Still, relative variations were reduced by 20-35, 40 and 60% approximately for "all personnel", MDs and psychologists respectively. In spite of a major increase in the supply of MDs and psychologists, absolute variations in the personnel ratios were in all cases either reduced, or fairly stable. These results give little support to the views expressed by the opponents of the 1980 reform, although the main result seems to have been relocations in the production of services, more than re-distributions in the consumption of services. DISCUSSION: These results can be seen as a result of three aspects of the reform: 1 Distributing government grants to counties in their capacity as users of services rather than producers of services. This shift has primarily facilitated relocations in the production of services. 2 Relocation of services was also expected to produce a more equal distribution in the use of services, since reduced distances would increase accessibility. This, however, was counteracted by increased county control with use of services in other counties. 3 Distribution of grants based on "needs" rather than services produced was expected to produce a more equal distribution in the use of services. This effect seems to have been less than expected, probably because counties with high reimbursements under the old system also provided services to people from other counties. Other policy reforms have, however, contributed to the results. These reforms include increased supply of personnel, de-institutionalization of services, regionalization/sectorization of services, and the establishment of smaller psychiatric units in general hospitals. POLICY IMPLICATIONS: In recent years the 1980 reform has been under attack; partly due to alleged inequalities created by the system. As a result of the critique, government reimbursements for in-patient treatment have been reintroduced for general hospital services. In mental health services, more resources are distributed to specific projects. According to this study, this shift in policy is based on faulty premises and might lead to greater inequalities in the future.

Journal Article↗
PubMed1998

[Acceptance of digital image distribution in a "filmless hospital"].

PURPOSE: Since October 1996 a hospital-wide digital image distribution has been added to the PACS of the central radiology department in the Barmherzigen Brüder hospital in Regensburg. In this way an almost film-less procedure has been realized in the hospital. An extensive questioning of the non-radiology physicians is intended to determine the strengths and weakness of the digital image distribution and the general acceptance of the system. MATERIALS AND METHODS: The installed system consists of the PACS of the radiology department and 50 image distribution work stations in all outpatient departments, wards, and operating theaters. RESULTS: 78.8% of the non-radiology physicians of the main departments participated in the study. The acceptance by the participants was highly positive; 90% of them experienced a facilitation of the routine work. CONCLUSIONS: The digital image distribution is also accepted by non-radiology physicians and makes a major contribution to the improvement of procedures in clinical routine.

Attitude of Health Personnel↗