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PubMed1998

A resource-allocation model to enhance productivity of academic physicians.

The authors describe a resource-allocation model developed in the Medical Care Clinical Center at the Baltimore Veterans Affairs Medical Center (a part of the VA Maryland Health Care System) and implemented in 1989. This model is a computer-based system that tracks the workload of each of the clinical center's specialty sections (e.g., cardiology) and calculates each section's workload as a percentage of the total clinical center workload. As the basis of this calculation, six activities of each section are tracked by the model (e.g., inpatient attending physicians' rotations; inpatient consultations; etc.) to determine what percentage of each activity of the entire clinical center was provided by each section. Each of these percentages is then recalculated according to a weighted average based on the relative value of the activity to the department; these averages are revised periodically as needed. The model provides an incentive for the specialty sections to increase productivity by generating competition among sections for physician salary support. Communication among all concerned at the clinical center and its associated medical school and teaching hospital has been the key to success in implementing the model, which is periodically reviewed and has been revised several times after meetings with section chiefs and division heads. The authors are confident that the use of the model has been at least partly responsible for increased productivity of clinical center physicians, especially in the areas of visits per physician and funded VA research dollars per physician. Perhaps equally important is the future potential of the model. Because of its simplicity and because it is generally seen to be fair and effective, it will continue to be used to reward activities most important to the clinical center, especially now that the center operates under a fully capitated system, and in this way wil help ensure the financial viability of the center.

Academic Medical Centers↗
PubMed1983

Planning and politics of resource allocation for primary health care: promotion of meaningful national policy.

Securing resources for primary health care (PHC) involves consideration of the entire health sector: the higher levels of the health service as well as the primary level, and the private and/or social security sub-sectors as well as the government service. Reshaping resource distribution is less a redistribution of existing resources than the allocation of new resources in accordance with PHC priorities. In this the planning of future current costs is a crucial element and requires a budgetary system that identifies expenditures by geographical area and level of care. Resources should be allocated geographically to reduce health care inequalities through the provision of an appropriate mix of different levels of care. Central resource planning and local health care programming (with 'dialogue' between the two) should be the basic planning division of labour, which largely resolves the so-called top-down/bottom-up dichotomy. The private medical sub-sector exerts economic, ideological and political influences on the public health service. Compulsory health insurance schemes can have some similar effects. Success of a PHC policy requires that governments adopt a holistic approach to the health sector. The allocation of health care resources on the bases of need and equity, as opposed to demand, is a political decision. The establishment of a national PHC policy backed up by adequate resources involves a specific politico-technical exercise with four components: research, planning, policy formulation, and government policy decision-making. The resource planning method, based on social epidemiology, is contrasted with conventional health planning methods, based on epidemiology. The articulation of these two approaches is discussed in terms of WHO's Managerial Process for National Health Development.

Costs and Cost Analysis↗
PubMedDate not supplied

Computerized hospital on-line resources allocation link (CHORAL): a mechanism to monitor and establish policy for hospital ambulance diversions.

Ongoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources. Data were not available for use in establishing policy. In response, this community developed an on-line, computerized system known as Computerized Hospital On-Line Resources Allocation Link (CHORAL) that visually displays the resource status of all hospitals to the 911 center, base station, and participating hospitals. A change of status requires simple keystrokes for entry into the computer which in turn transmitted automatically to all other CHORAL computers. Six patient care resources are monitored: Adult Ward (AW); Computerized Axial Tomography Scan (CT); Critical Care (CC); Labor and Delivery (LD); Pediatric (PEDS); and Psychiatric Secure Beds (PSB). Paramedics use protocol to determine if a particular patient fits one of these categories. Availability is relayed to paramedics by the 911 center and the base-station. During the first three months of system operation, there were 337 diversions representing 4,527 hours among 10 of the 12 participating hospitals. The most common resource resulting in diversion was PSB, which was unavailable for 2,195 hours (48.5%). Unavailability of CT resulted in the lowest number of diversions (1.3%, 60.3 hours).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗
PubMed1989

A policy-based CE resource allocation algorithm.

The cost of a health facility's continuing education (CE) program varies with facility size, mission, and its location or accessibility to sources of CE. This paper describes the development and use of a policy model and algorithm for allocating CE dollar resources in a large national health system. The algorithm uses a two-factor model, basing facility CE dollar allocations on the amount of CE need and price differences in accessing CE sources.

Algorithms↗
PubMed2024

Variable resource allocation pattern, biased sex-ratio, and extent of sexual dimorphism in subdioecious Hippophae rhamnoides.

Evolutionary maintenance of dioecy is a complex phenomenon and varies by species and underlying pathways. Also, different sexes may exhibit variable resource allocation (RA) patterns among the vegetative and reproductive functions. Such differences are reflected in the extent of sexual dimorphism. Though rarely pursued, investigation on plant species harbouring intermediate sexual phenotypes may reveal useful information on the strategy pertaining to sex-ratios and evolutionary pathways. We studied H. rhamnoides ssp. turkestanica, a subdioecious species with polygamomonoecious (PGM) plants, in western Himalaya. The species naturally inhabits a wide range of habitats ranging from river deltas to hill slopes. These attributes of the species are conducive to test the influence of abiotic factors on sexual dimorphism, and RA strategy among different sexes. The study demonstrates sexual dimorphism in vegetative and reproductive traits. The sexual dimorphism index, aligned the traits like height, number of branches, flower production, and dry-weight of flowers with males while others including fresh-weight of leaves, number of thorns, fruit production were significantly associated with females. The difference in RA pattern is more pronounced in reproductive traits of the male and female plants, while in the PGM plants the traits overlap. In general, habitat conditions did not influence either the extent of sexual dimorphism or RA pattern. However, it seems to influence secondary sex-ratio as females show their significant association with soil moisture. Our findings on sexual dimorphism and RA pattern supports attributes of wind-pollination in the species. The observed extent of sexual dimorphism in the species reiterates limited genomic differences among the sexes and the ongoing evolution of dioecy via monoecy in the species. The dynamics of RA in the species appears to be independent of resource availability in the habitats as the species grows in a resource-limited and extreme environment.

Hippophae↗
PubMed1989

Resource allocation decisions in critical care nursing.

One of the major challenges for critical care nurses is to distribute their professional services in a manner that is consistent with the moral imperatives of nursing. The central values of respect for individual patients, patient-centered beneficence, full beneficence, and justice must be woven together into an ethical framework that assists nurses in allocating their skills. Professional organizations, such as the AACN, are actively trying to order this ethical disorder by proposing guidelines that, on the one hand, acknowledge societal interests in cost-effective utilization of health care resources, and on the other hand, safeguard the interests and well-being of individual patients. In addition to the guidance from professional organizations, health care institutions should address the inequities in health care by developing policies that guide the health care team through an ethical decision-making process. Nurses, as members of the multidisciplinary health care team and as members of an essential and scarce resource, should participate in formulating these directives. Not only is bedside and institutional involvement important, but participation at the local, state, and national levels will empower nurses to influence decisions of resource allocation at the micro and macro levels.

Beneficence↗
PubMed2000

Stability in Natural Bacterial Communities: II. Plant Resource Allocation Effects on Rhizosphere Diazotroph Assemblage Composition.

Plant rhizospheres are dynamic environments in which microbes compete for resources, particularly plant-derived organic carbon/energy sources. Altering plant productivity changes the availability of carbon/energy resources to rhizosphere microbiota. This limitation is expected to intensify competition for the remaining carbon supply and could cause the loss of poor competitors from the assemblage. We clipped or shaded plots of the salt marsh cord grass, Spartina alterniflora, to shift plant carbon resource allocation from the rhizosphere to the aboveground shoots. We then examined key porewater parameters (pH, salinity, H(2)S, NH(+)(4)), diazotrophic activity (by acetylene reduction assay), and diazotroph assemblage composition after 2 weeks or 8 weeks of treatment. The diazotroph assemblage composition was monitored via the polymerase chain reaction using nifH specific primers followed by denaturing gradient gel electrophoresis (DGGE) analysis. Porewater parameters and acetylene reduction rates did not differ significantly among treatments. The DGGE profiles also were very similar across the control and experimental treatments, indicating that no detectable diazotroph species were displaced from the assemblage. This implies that rhizosphere diazotrophs are able to compete successfully against nondiazotrophs, in spite of the high energy requirements of nitrogen fixation. These results show that the species composition of the diazotroph assemblage in the S. alterniflora rhizosphere is stable in the face of short-duration but potentially high-impact variations in carbon resource availability. </hea

Journal Article↗
PubMed1990

Stimulus miscuing and dishabituation: electrodermal activity and resource allocation.

The present research investigated the effects of miscuing a shock stimulus on dishabituation of the skin conductance response and on the allocation of processing resources. In both experiments, a control group received 21 S1-S2 pairings intermixed with 23 S3-alone presentations. For the experimental group, S2 was miscued on trials 11 and 22 by its presentation following S3. In Experiment 1 (N = 48), S2 was a shock that was either "clearly discernible" or "uncomfortable but not painful". The results indicated increased electrodermal responding when S2 was miscued by S3 and subsequent dishabituation when S2 again followed S1 on the next trial. Miscuing produced dishabituation with both a high- and low-shock S2. A continuous measure of S2 expectancy revealed that expectancy of S2 in the presence of S1 declined as a result of miscuing. Experiment 2 (N = 36) employed reaction time to a white noise probe stimulus as the dependent variable. The critical data came from probes presented 300 ms following S2 onset on the S1-S2 trial immediately following miscuing. They indicated that miscuing produced slowed reaction time to probes presented during S2 on the following S1-S2 trial. Thus, the miscuing of S2 by S3 appears to result in an increase in processing resources devoted to S2, even when S2 is presented in its usual position following S1. The results are discussed in terms of current theories of associative learning.

Adult↗
PubMed2000

ERP indices of resource allocation difficulties in mild head injury.

This study examined the hypothesis that distractibility is a characteristic sequela of mild closed head injury (MHI). The Minnesota Multiphasic Personality Inventory (MMPI-2) was used to study whether comorbid stress-related symptoms are associated with behavioral and electrophysiological indexes of attention. Event-related potentials (ERPs) and performance (reaction time, accuracy) were studied in patients with MHI (n = 20), patients with frontal lesions (n = 14), and healthy controls (n = 20) during a three-tone oddball task. Participants were instructed to detect rare target (2000 Hz) tones, and to withhold responding to equally rare distractor (500 Hz) tones and frequently occurring standard (1000 Hz) tones. All groups distinguished the two classes of deviants as indicated by the larger P3 amplitude to target relative to distractor tones. This indicates that the group with MHI was capable of differential allocation of attentional resources to target and non-target events. However, impaired performance and attenuated ERP amplitudes to both classes of deviants relative to patients with frontal lesions and controls, suggest limited availability, or expenditure of the resources needed for adequate task performance. In the group with MHI, both P3 amplitude and reaction time (RT) were significantly related to subjectively reported distress. The difference in RT disappeared, whereas the P3 amplitude differences between the patient groups remained when adjusting for level of distress.

Acoustic Stimulation↗
PubMed2000

Professional assessment of optimal nursing care intensity level. A new method for resource allocation as an alternative to classical time studies.

In the article a new method is presented for allocation of staff resources, 'Professional Assessment of Optimal Nursing Care Intensity Level' (PAONCIL). This method is presented as an alternative to classical time study, which has traditionally been considered to belong to systems for patient classification. By means of this method the optimal nursing care intensity level for individual wards can be established. The study comprised 8 wards, and the nurses working in these wards provided a total of 8,458 professional assessments of optimal nursing care intensity levels. The material was analysed by means of simple linear regression analysis. The nursing care intensity scores per nurse in a single ward were used as independent variables and the average PAONCIL score for the same calendar day was used as a dependent variable. The average determination coefficient for different wards were 0.37; the PAONCIL instrument thus explained 37% of the nursing care intensity/nurse variation. This corresponded to a linear correlation of 0.60. In five out of six wards for adults the optimal nursing care intensity/nurse scores were close to each other, ranging from 3.0 to 3.6. The advantage of the PAONCIL method is that it can be easily implemented in a ward, can be used time and again, is advantageous and is based on quality aspects. The PAONCIL method has been developed on the basis of a caring science perspective and can be seen as an administrative method for the nurse manager, with whose help 'good care' can become possible.

Clinical Nursing Research↗
PubMedDate not supplied

Resource allocation. The cost of care: two troublesome cases in health care ethics.

With the cost of health care rising rapidly, both physicians and administrators regularly face resource allocation decisions. Under these conditions of relative scarcity, the equitable and appropriate distribution of limited resources becomes an ethical as well as a financial issue. Through ethical analysis, physician executives can assist their physician colleagues and fellow administrators to find rationally defensible answers to questions regarding the distribution of limited resources. Six criteria are frequently "weighted in the balance" by ethicists when analyzing whether justice is served in the distribution of a limited resource: need, equality, contribution, ability to pay, effort, and merit. The authors argue that, from an ethical standpoint, the best single criterion upon which one can base an allocation decision is that of merit, defined as the potential to benefit from the investment of additional resources.

Decision Making↗
PubMed2000

Resource allocation between reproductive phases: the importance of thermal conditions in determining the cost of incubation.

Changes in the resources allocated to particular stages of reproduction are expected to influence allocation to, and performance in, subsequent reproductive stages. Experimental manipulation of individual investment patterns provides important evidence that such physiological trade-offs occur, and can highlight the key environmental variables that influence reproductive costs. By temporarily altering the thermal properties of starling nests, we reduced the energetic demand of first-clutch incubation, and examined the effect of this manipulation on performance during the same and the subsequent reproductive attempts. Compared with controls, starlings investing less in incubation were more successful in fledging young, and were more likely to hatch all their eggs if a subsequent reproductive attempt was made. Our results show that incubation demands can limit reproductive success, and that resources saved during incubation can be reallocated to later stages of the same reproductive attempt and to future reproductive attempts. This study also shows that small changes in thermal environment can affect breeding success by altering the energetic demands imposed on incubating parents, independently of the effect of temperature on other environmental variables such as food supply.

Animals↗
PubMed2000

A trauma resource allocation model for ambulances and hospitals.

OBJECTIVE: To develop a mathematical model for the location of trauma care resources. DATA SOURCES/STUDY SETTING: Severely injured patients queried from Maryland hospital discharge and vital statistics data. A spatial injury profile was created by parsing these patients into ZIP codes. STUDY DESIGN: The Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) was formulated using integer and heuristic programming. To maximize coverage of severely injured patients, trauma centers and aeromedical depots were simultaneously sited using TRAMAH. A severe injury was considered covered if at least one trauma center was sited within a time standard by ground, or if an aeromedical depot-trauma center pair was sited in such a way that the sum of the flying time from the aeromedical depot to the scene of injury plus the flying time from the scene of injury to the trauma center was within the same time standard. PRINCIPAL FINDINGS: From 1992 to 1994, 26,774 severe injuries were considered for coverage. Across Maryland, 94.8 percent of severely injured residents had access to trauma system resources within 30 minutes and 70.3 percent had access within 15 minutes. For the same number of resources as the existing Maryland Trauma System, TRAMAH achieved a coverage objective of 99.97 percent within 30 minutes. This translated into an additional 461 severely injured people covered each year. Holding in place the trauma centers of the existing system, approximately the same percentage of coverage as that of the existing system was achieved within 15 minutes by optimally locating six fewer aeromedical depots. CONCLUSIONS: TRAMAH will allow trauma systems planners to better locate their resources with respect to spatial needs and response times.

Air Ambulances↗
PubMed1993

Psychopharmacology and the ethics of resource allocation.

The introduction of clozapine to current psychiatric practice is considered against a background of potential problems of resource allocation posed by the development of a number of 'budget-busting' drugs. It would appear that clinicians may increasingly have to operate within a climate in which the rights of individual patients to expensive treatments will seem to be pitted against the abilities of their communities to afford such treatments. Both clinicians and pharmaceutical companies have roles in the development of such conflicts.

Clozapine↗
PubMed2002

Reconstructionist Confucianism and health care: an Asian moral account of health care resource allocation.

In this article, I offer an abridged reconstruction of the foundational elements of Confucian moral commitments, which, I will argue, still provide the background moral substance for moral reflection in mainland China, Hong Kong, Taiwan, Singapore, and Korea. The essay presents implications of Confucianism for establishing an appropriate health care system and critically assesses the features of current health polices in mainland China, Hong Kong, and Singapore. The goal is to offer a family-oriented, non-individualist account of resource allocation that takes family authority and responsibility seriously.

Bioethics↗
PubMed1997

[Identification of disadvantaged areas; a system for resource allocation to family practitioners].

OBJECTIVE: To develop a method for the identification of underprivileged areas in the Netherlands for resource allocation to general practitioners. DESIGN: Literature review and analysis of national data. SETTING: All postal codes in the Netherlands. METHOD: Definition of requirements of the method, selection of required data and calculation of deprivation scores. RESULTS: The method developed includes an index, based on income and number of people receiving income from benefit schemes, calculated for very strongly urbanized areas. Overall 87 four-digit postal codes were identified as underprivileged areas in which 875,000 people live. About one in three inhabitants of the four largest cities is living in such area. CONCLUSION: For the first time in the history of Dutch health care a national method for the identification of underprivileged areas was developed. This method was adopted as a basis for making enhanced payments to general practitioners for patients living in these areas. Taking into account the availability of relevant data, the method developed is the most feasible at this stage, but it is not yet perfect. This is especially true for medium sized cities. Therefore, further validation and refinement of the method are needed.

Adolescent↗
PubMed1989

St Bartholomew's resources allocation scheme.

This scheme has three main features: it relates the output of work and materials from the department to the funding input (resource allocation), it enables the funding bodies to determine the level of output they are willing to support and it creates spare capacity to permit income generation either through charging for work done in excess of allocations made under the scheme or by attracting outside business. The system devolves upon the work unit as a measure of resource and this is made up of a combination of materials and time depending on the product. Derivation of work unit cost is given as a function of all reckonable operating costs of the department. Different profit margins may be applied according to category of request. Income is returnable to the funding bodies in the same ratio as their original provision to the service (for the current year of operation) after a deduction for reinvestment. The scheme allows for central funding to be progressively reduced to zero.

Cost Allocation↗
PubMed1983

Resource allocation and the attentional demands of letter encoding.

The idea that familiar events can be encoded automatically has gained general acceptance in cognitive psychology since Posner and Boies (1971) first reported that reaction times to a secondary probe were not interfered with by letter encoding. More recently, Ogden, Martin, and Paap (1981) used a more valid control for estimating baseline probe performance and found secondary task interference, suggesting that letter encoding does require attentional resources. The present series of experiments began with the aim of evaluating Ogden et al's evidence against automaticity when the first letter was not terminated after a brief exposure, as was done in their study. In the first set of experiments we found evidence of encoding interference when the interval between the two letters was varied (50 to 1,000 msec), but this interference disappeared when there was a constant 1,000-msec interval between the letters. On the basis of these findings, we hypothesized that changes in the primary task (e.g., the exposure duration of the first letter or the interval between the two letters) may influence the momentary allocation of resources between the primary and secondary tasks. More specifically, we hypothesized that any momentary reduction in the resources demanded by the primary tasks results in a reallocation of resources to the secondary task, which in turn reduces the sensitivity of the secondary task to the demands of the primary task, that is, probe performance is moved into the data-limited region of processing (Norman & Bobrow, 1975). This idea was tested by reducing resource allocation to the probe task at the time of encoding by reducing the expectancy (i.e., the probability) of probes in the temporal proximity of the first letter. The results showed that this manipulation produced a large and significant increase in encoding interference. Moreover, when the intensity of the tone (probe) was decreased from 70 to 60 dB, the magnitude of encoding interference was further increased. In regard to the specific issue of automaticity, the findings suggest that encoding familiar events does require resources, which will result in secondary task interference given that the secondary task is in the resource-limited region of processing. More important, the findings suggest that the magnitude of secondary task interference is dependent on within-trial changes in resource allocation between the primary and secondary tasks. This possibility has general implications for dual-task methodology and the measurement of attentional demands.

Adult↗