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PubMed1992

A dialogue on stewardship. A multiunit organization commits to improving utilization of scarce resources.

To initiate a dialogue and begin addressing the issues of appropriateness of patient care and resource utilization, since 1988 leaders within the East Central Region of the Daughters of Charity National Health System (DCNHS-EC) have conducted a series of workshops involving managers, physicians, ethicists, attorneys, and others. The dialogue initiated in these workshops, along with the results of a 1991 survey of the region's local health ministries, has provided DCNHS-EC with baseline information on how each of the region's institutions supports care givers in making ethical decisions at the bedside level. The first workshop focused on the ethical dimensions of providing high-quality care with reduced reimbursement, local initiatives for ensuring quality while containing costs, and steps DCNHS-EC hospitals could take to promote effective use of scarce medical resources. Subsequent workshops provided opportunities for further exploration of these issues. Another workshop is being planned for late 1993 or early 1994. DCNHS-EC health ministries are taking a number of concrete steps to improve appropriateness of care and resource utilization. The support of local management, governance, and physician leaders is critical to these efforts.

Catholicism↗

PubMed1993

Resource allocation and the beginning of life.

Like many other countries, Australia is increasingly being forced to face the spiralling costs of health care. Population increases, an aging population, and the high cost of many items of modern medical equipment and of medical care generally, have all contributed to the pressure on health care resources. Within this climate of resource scarcity, more and more questions are being asked about the prioritization of items of health expenditure. The aim of this article is to consider the claim of reproductive technology, prenatal care, and prenatal diagnosis on health care resources and to evaluate the balance between treatments and preventative measures.

Australia↗

PubMed1995

What is resource management?

Healthcare is changing rapidly. One of the most significant changes is the way that modern society views healthcare. In response to public demand for high-quality care at low cost, providers have to take a broader, more encompassing view of the total cost of patient care. Resource management is emerging as the discipline to integrate the healthcare delivery process. Resources comprise time, money, people, facilities, equipment, information, pharmaceuticals, and fixed assets. The central question for every healthcare provider is: "How can I optimize resources to maximize patient wellness?"

Health Care Rationing↗

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↗

PubMed1998

Physician resource profiling enhances utilization management.

Physician resource profiling, the analysis of a physician's resource consumption, enhances performance uniformity and efficiency and assists in utilization management. Developing reliable profiles requires the shared participation of an organization's finance personnel and physicians. Selecting or developing benchmarks for performance comparisons, assessing the integrity of the organizational data used, and testing the developed profiles all should be completed before the physician resource profiling can be used to support decision making.

Benchmarking↗

PubMed1998

The provision of primary health care, in two rural districts of the Eastern Cape Province with particular reference to human resources and accessibility. Part 1.

The provision of Primary Health Care Services (PHC) is still a problem in developing countries like South Africa. In other countries, one finds enough human resources whilst in other countries there may be enough material resources. A both qualitative and quantitative research was conducted at Mqanduli and part of the Eastern Elliotdale districts in the Eastern Cape Province with the aim of investigating the provision of Primary health Care Services, reference was made to the availability of human resources and accessibility of PHC services. An explorative, descriptive and contextual design was selected for the purpose of this study. It followed a two phased approach in the collection of data. Phase I consisted of a sample of 200 subjects that were drawn from the community members; whilst Phase II was made up of 20 professional nurses working in ten clinics. Interview schedules and questionnaires were used as methods of data collection, respectively. The data were analysed by means of a computer software package called SAS, whilst content analysis of qualitative data was done by the researchers independent of each other. Part II of the article gives a full description of the results and the recommendations.

Attitude to Health↗

PubMed2001

Effect of sumatriptan on health care resource use among patients with migraine.

Previous investigations examining health care resource utilization in patient populations have shown patients with migraine to consume significantly higher health care resources compared with individuals without migraine. The purpose of this study was to compare health care resource and narcotic use in migraineurs prescribed sumatriptan (oral, subcutaneous, or nasal) with those not prescribed sumatriptan.

Adult↗

PubMed2003

Resources for controlling tuberculosis in Malawi.

OBJECTIVE: To document resources for controlling tuberculosis (TB) in Malawi. METHODS: We performed a countrywide study of all 43 hospitals (3 central, 22 district and 18 mission) which register and treat patients with TB. To collect data for 1998 on the TB-related workload, diagnostic facilities, programme staff and treatment facilities, we used laboratory, radiographic and TB registers, conducted interviews and visited hospital facilities. FINDINGS: The data show that in 1998, 88,257 TB suspects/patients contributed approximately 230,000 sputum specimens for smear microscopy, 55,667 chest X-rays were performed and 23,285 patients were registered for TB treatment. There were 86 trained laboratory personnel, 44 radiographers and 83 TB programme staff. Of these, about 40% had periods of illness during 1998. Approximately 20% of the microscopes and X-ray machines were broken. Some 16% of the hospital beds were designated for TB patients in special wards, but even so, the occupancy of beds in TB wards exceeded 100%. Although stocks of anti-TB drugs were good, there was a shortage of full-time TB ward nurses and 50% of district hospitals conducted no TB ward rounds. In general, there was a shortage of facilities for managing associated HIV-related disease; central hospitals, in particular, were underresourced. CONCLUSION: Malawi needs better planning to utilize its manpower and should consider cross-training hospital personnel. The equipment needs regular maintenance, and more attention should be paid to HIV-related illness. The policies of decentralizing resources to the periphery and increasing diagnostic and case-holding resources for central hospitals should be continued.

Antitubercular Agents↗

PubMedDate not supplied

General hospital resources consumed by an elderly population awaiting long-term care.

The provision of extended care facilities in urban Ireland has lagged behind the growth in the numbers of older people. A final pathway for placement is often through the general hospital and the attendant delay results in a diversion of resources. We developed a database of the long-term care waiting lists for the years 1994-present and this was analysed for the six years 1994-1999. We calculated the number of bed-days consumed by elderly patients awaiting placement in long-term care facilities and thus the hospital resources consumed during these periods. The total number of bed-days consumed over the study period was 51,923, the mean being 8653.8 days. Approximately 23.9% of patients die in hospital while awaiting long-term placement. Translating these bed-days into opportunity cost losses in areas relevant to the general hospital we found that 560 extra elective orthopaedic procedures and 1,212 extra transurethral prostatectomies could have been performed per year. The problem of overnight stays in casualty could have been totally abolished if only 65% of these beds were free. Elective theatre is often cancelled with one of the primary reasons being lack of beds. If even a proportion of these beds could be freed up few if any theatre sessions would have to be cancelled, assuming bed availability to be the only factor. This study confirms that the lack of appropriate accommodation for older people requiring extended care is consuming a significant proportion of health care resources. An accelerated program of building of publicly funded long-term placement facilities is urgently required to ameliorate this problem, especially in the greater Dublin area. Further study is required to determine whether this problem exists in other health board areas and if so whether it exists to the same extent.

Age Distribution↗

PubMed2002

Surgical case costing: trauma is underfunded according to resource intensity weights.

OBJECTIVE: To determine whether rate-based funding using resource intensity weights (RIWs) adequately represents trauma case costs. DESIGN: A prospective time-in-motion resource utilization pilot study to assure the effectiveness of the computerized hospital Transition-One data acquisition system, followed by a retrospective observational case costing study. Patient costs with no identifing data were used, and all costs were tabulated as mean cost per group. SETTING: London Health Sciences Centre, London, Ont., a tertiary care "lead" trauma hospital. PATIENTS: A modified random selection of 4 control case mix groups (CMGs) of surgical patients for the fiscal year 1996-97. The trauma group was selected as a representative resource-intensive CMG. Each patient was assigned to a CMG by Health Records according to the most responsible diagnosis. OUTCOMES MEASURES: Total case costs were tabulated for each patient then combined for a mean case cost per CMG. The RIW assignments for each patient were combined to create a mean RIW per CMG and mean length of stay per CMG. RESULTS: There was no statistically significant difference between the control surgical CMGs and the trauma CMG for mean RIW-adjusted length of stay per CMG, but there was a significant difference (p < 0.0001) between the control CMGs and the trauma CMG for RIW-adjusted mean case cost per CMG. CONCLUSIONS: RIWs underrepresent trauma case costs by a factor of 3.5, which could result in underfinding and potential fiscal difficulties for leading trauma hospitals as has occurred in the United States.

Diagnosis-Related Groups↗

PubMed2002

Water from (waste)water--the dependable water resource.

Water reclamation and reuse provides a unique and viable opportunity to augment traditional water supplies. As a multi-disciplined and important element of water resources development and management, water reuse can help to close the loop between water supply and wastewater disposal. Effective water reuse requires integration of water and reclaimed water supply functions. The successful development of this dependable water resource depends upon close examination and synthesis of elements from infrastructure and facilities planning, wastewater treatment plant siting, treatment process reliability, economic and financial analyses, and water utility management. In this paper, fundamental concepts of water reuse are discussed including definitions, historical developments, the role of water recycling in the hydrologic cycle, categories of water reuse, water quality criteria and regulatory requirements, and technological innovations for the safe use of reclaimed water. The paper emphasizes the integration of this alternative water supply into water resources planning, and the emergence of modern water reclamation and reuse practices from wastewater to reclaimed water to repurified water.

Conservation of Natural Resources↗

PubMed2002

Resource utilization related to atrial fibrillation after coronary artery bypass grafting.

BACKGROUND: Studies of resource utilization by patients with new-onset atrialfibrillation after coronary artery bypass grafting have addressed only length of stay and bed charges. OBJECTIVE: To compare resource utilization between patients with new-onset atrial fibrillation and patients without atrialfibrillation after isolated coronary artery bypass grafting. METHODS: Retrospective review of clinical and administrative electronic databases for 720 subjects who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass in 25 months at one medical center The prevalence of atrial fibrillation was determined, and resource utilization in various hospital cost centers was compared between subjects with and without atrialfibrillation. RESULTS: The prevalence of new-onset atrial fibrillation was 33.1%. Compared with subjects without atrialfibrillation, subjects with atrialfibrillation had a longer stay (5.8 +/- 2.4 vs. 4.4+/-1.2 days, P<.001), more days receiving mechanical ventilation (P =.002) and oxygen therapy (P<.001), and higher rates of readmission to the intensive care unit (4.6% vs. 0.2%, P<.001). Subjects with atrial fibrillation also had more laboratory tests (P<.001) and more days receiving cardiac drugs, heparin, diuretics, and electrolytes. Subjects with atrialfibrillation had higher total postoperative charges ($57261 +/- $17101 vs. $50905 +/- $10062, P = .001), a mean difference of $6356. The mean differences were greatest for bed charges ($1642), laboratory charges ($1215), pharmacy ($989), and respiratory care ($582). CONCLUSION: The economic impact of atrialfibrillation after coronary artery bypass grafting has been underestimated.

Aged↗

PubMed2000

[Studies on medicinal plant resources of heizhu ravine in Ebian County and their sustainable utilization].

OBJECTIVE: To find out the medicinal plant resources of Heizhu Ravine in Ebian County and put forward some principles and measures for their sustainable utilization. METHOD: On-the-spot investigation and sample measuring, calculating, visiting and assessing. RESULTS: The general situation about these resources was expounded. New curative effects of 3 species, distribution and region output of 7 superiority resource species, 1 plant pesticide species, 3 species suitable for extensive propagation and 7 rare species on the verge of extinction were also reported. CONCLUSION: This area has more than 1500 species of medicinal plants, of which about 300 are original traditional Chinese medicinal herb in most use and 1200 are used in folk medicine or as important medicinal raw mAterials.

China↗

PubMed1999

[An approach to some problems on utilization of medicinal plant resource in China].

OBJECTIVE: To provide some reference for the research on the utilization of medicinal plant resources. METHOD: Based on a review of the achievements in utilizing medicinal plant resources, three aspects were discussed: the utilization and conservation of the endangered and rare medicinal plants; the research on the authenticity and superiority of medicinal plants; and the quality control and evaluation of medicinal plants. RESULTS: Although great achievements have been made, some problems still exist. CONCLUSION: The research on the development and utilization of medicinal plant resources has broad prospects.

Conservation of Natural Resources↗

PubMed2000

[Resources distribution and pharamacognostic identification of Centella asiatica (L.) urban produced in China].

OBJECTIVE: To investigate the resources distribution and morphological histology of Centella asiatica distributed in China, and offer evidences for exploiting the plant resources and drafting the quality standards. METHOD: Sample collection, document investigation and microscopic section observation. RESULT: A table of resources distribution was worked out, the medicinal properties and the microscopic characteristics of the stem, leaf and stipe were described. CONCLUSION: This study supports the viewpoint of Urban and can be used as a reference for the quality standard of Centella asiation.

Centella↗

PubMed2002

Coastal resources and management systems influenced by conflict and migration: Mecúfi, Mozambique.

Coastal resource utilization and management systems, both traditional and more recently conceived, were studied in Mecúfi district, northern Mozambique in a post-conflict situation prior to which a significant migration of people to the coast had occurred. A wide variety of coastal biotopes containing a multitude of resources had been affected in various ways. Intertidal organisms exhibited signs of decreasing abundance and average size, whereas offshore fishes and mangrove forests did not show signs of over-utilization. It was observed that traditional coastal management systems were still influential, but that newer initiatives were only beginning to enter into significant dialogue and cooperation with these. In the current circumstances of peace and political stability, the principal threat to coastal management and the interests of local people in Mecúfi is considered to be potential loss of common property resources and land tenure in the face of prospects of privatization, but Mozambican authorities are presently addressing these issues with legal reforms.

Animals↗

PubMed2003

Improving resource utilization in the intensive care units. A challenge for Saudi Hospitals.

In the face of increasing demand of intensive care services in the Kingdom of Saudi Arabia, as well as the high cost of delivering such services, systematic steps must be undertaken in order to ensure optional utilization and fair allocation of resources. Strategies start prior to intensive care units (ICU) admission by the proper selection of patients who are likely to benefit from ICU. Less resource-demanding alternatives, such as intermediate care units, should be used for low-risk patients. Do-not-resuscitate status in patients with no meaningful chance of recovery will prevent futile admissions to ICUs. Measures known to improve the efficiency of care in the ICU must be implemented, including hiring full-time qualified intensivists, switching open units to closed ones and the introduction of certain evidence-base driven management protocols. On discharge, the intermediate care units again play a role as less expensive alternative transitional area for patients who are not stable enough to go to general ward. Measures to reduce re-admissions to ICU must also be implemented. Improving ICU resource utilization requires teamwork not only the intensivists but also the administrators and other health care providers.

Health Services Needs and Demand↗

PubMed2003

Decentralization and equity of resource allocation: evidence from Colombia and Chile.

OBJECTIVE: To investigate the relation between decentralization and equity of resource allocation in Colombia and Chile. METHODS: The "decision space" approach and analysis of expenditures and utilization rates were used to provide a comparative analysis of decentralization of the health systems of Colombia and Chile. FINDINGS: Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization--the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization. CONCLUSION: Decentralization can contribute to, or at least maintain, equitable allocation of health resources among municipalities of different incomes.

Chile↗