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PubMed1980

The relationship between medical resources and measures of health: some additional evidence.

The relationship between an area's medical resources and physiological measures of individual health status is examined. Variables such as age, sex, race, education, and income are controlled for. The physiological measures include diastolic blood pressure, serum cholesterol concentration, electrocardiogram, chest X-ray, varicose veins, and periodontal disease. Although additional education and income were associated with fewer abnormal chest X-rays and less periodontal disease, the physiological measures were little affected by additional medical resources. The results are consistent with the view that what the individual does (or does not) do for himself affects health more than do additional medical resources.

Adolescent↗

PubMed1981

Allocation of scarce resources: some problems.

This paper presents an overview of current philosophical perspectives and societal trends in relation to allocation of scarce resources. An analysis and comparative assessment of various positions of current philosophers, theologians, and bioethicists is provided. Currently proposed cost containment measures at the federal level require that black health professionals particularly pay attention to these proposals specifically as related to allocation of resources. The ways in which cost containment and/ or modification of resource allocation will affect health care delivery, specifically for the black community, must be carefully examined. This article may suggest some approaches for individual and group response to the continuing dialogue and to the allocation process itself. The equitable distribution of health care, particularly scarce new technologies, will be one of the greatest problems facing society in the next 20 years.

Black or African American↗

PubMed1994

The effect of physician practice organization on efficient utilization of hospital resources.

OBJECTIVE: This study examines variations in the efficient use of hospital resources across individual physicians. DATA SOURCES AND SETTING: The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. STUDY DESIGN: The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. PRINCIPAL FINDINGS: After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. CONCLUSIONS: The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior.

Arizona↗

PubMed1994

Zidovudine therapy and health resource utilization in AIDS.

We wished to determine whether antiretroviral therapy with zidovudine first received when a person is diagnosed with AIDS was associated with diminished or increased direct health resource utilization. As a measure of health resource utilization, we examined all Medicaid-administered health care charges to adult Maryland residents diagnosed with AIDS from 1987 to 1989 who were part of the Human Immunodeficiency Virus Information System. We specifically compared those persons who first received zidovudine therapy either prior to or within 60 days of diagnosis of AIDS (n = 101) with those who never received zidovudine therapy (n = 279). Median survival time after diagnosis of AIDS in those who received zidovudine was 605 days and in those who did not receive zidovudine 235 days. After diagnosis of AIDS, median per-person lifetime direct health care charges to Medicaid were $66,200 in those who received zidovudine and $31,300 in those who did not receive zidovudine. The median incremental charge per year of life gained in zidovudine users was $34,600 compared with nonusers. Adjusting by proportional hazards regression for age, gender, race/ethnicity, HIV transmission risk group, AIDS-defining diagnosis, and length of follow-up, lifetime Medicaid charges were higher in zidovudine receivers. Compared with patients who did not receive zidovudine, patients who first received zidovudine at the time AIDS was diagnosed incurred higher cumulative lifetime charges, associated principally with longer survival time. The rate of resource utilization was not decreased by zidovudine use.

Acquired Immunodeficiency Syndrome↗

PubMed1993

The vulnerable elderly. Predicting necessary resources.

This article describes elderly patients who are at risk and the resources they need. It goes on to describe an efficient system that makes optimum use of resources, provides a continuum of care, and makes it easier to predict the resources that a community will require.

Aged↗

PubMed1995

Toward an improvement of life optimizing resource use.

In this paper an object-oriented system for the storing and the managing of epidemiological data in order to decrease the incidence of a given groups of diseases by means of health care strategy application and of the relative health care resource allocation is described. The system starts from the present epidemiological situation of the territory examined and from the real distribution on this territory of human and material health care resources. The health care manager inputs the available budget, some information regarding the population living on this area, other geographical and climatic informations, the values of certain epidemiological parameters of the diseases considered--the system has stored the mathematical and departmental models of these diseases--and the system allocates (using own allocation algorithms) human and material health care resources, optimizing the cost-benefit rate.

Algorithms↗

PubMed1995

Resource management progress of the program in the NHS in England.

1. HISTORY. The program began in 1986 as the Resource Management Initiative and had just six pilot sites. In 1989, Ministers decided to establish a national Resource Management Programme covering all general acute Hospitals in England with more than 250 beds--some 250-260 sites in all. A range of community units also embarked on a program of pilot projects aimed at testing the RM principles in those services. 2. ELEMENTS OF THE PROGRAM. A site joining the program was expected to submit a case based on readiness for inclusion, supported by an outline project plan before approval could be given. The plan encompassed a range of elements, but was individual to each unit; the philosophy being that each unit was being assisted to reach its own objectives within an overall framework. The elements of the framework were as follows: a) A vision of what was expected to be achieved by the project and the benefits being sought; b) A focus on improving the quality of patient care in the unit; c) Involving clinicians in the management process; d) The availability of clinical information to support decision-making; this included the hardware and software for Case-Mix Management and Nurse Management Systems, but also extended to coding, classifying, and grouping systems. e) A greater awareness of the financial implications of clinical decisions; f) A project management approach to implementation; g) An approach based on developing both the organization and its staff, with training. 3. THE KEY TO RM IMPLEMENTATION IS CULTURAL CHANGE AT THE UNIT LEVEL. While steps to achieve this change can be planned and driven forward via the project plan, the very nature of the project means that a more flexible and "soft systems" view of success is appropriate. Local ownership of the process is essential and can lead to a very specific view of "success." 4. BENEFITS. Demonstrating primary causality is difficult as eight years have elapsed since the program was started, and this has coincided with a period of radical change. However certain matters are beyond dispute: The vast majority of units have adopted one form or other of Clinical Directorate structure. Many clinical staff are formally engaged in the operational and general management process. Some RM sites are advantageous when it comes to negotiating with their purchaser organizations because they have better quality data on which to base the process. The use of Casemix Management and Nurse Management Systems is seen in some RM sites as improving the quality of patient care provided. RM has focused attention on clinical coding and grouping. RM has exposed the need to develop or reassess Information Strategies at unit level. RM has stimulated staff training and development at site level and has been instrumental in improving the quality of training facilities, resources, and materials that are available. RM is recognized as having had a catalytic effect on changes associated with the NHS Reforms. 5. CONCLUSION. Good quality services require well-managed and competent provider organizations. The RM program was designed to assist the improvement of provider unit management. There is general agreement that the principles of RM should be taken forward in the broader context of provider development, with a focus on quality as well as financial issues.

England↗

PubMed1996

The impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective.

OBJECTIVE: Using resource dependency theory as a conceptual framework, this study investigates both the organizational and environmental factors associated with an emerging health care service delivery innovation, the provision of specialty care in designated units in nursing care facilities. We consider two types of specialty units, Alzheimer's Disease and subacute care. DATA SOURCES: The Medicare/Medicaid Automated Certification Survey (MMACS) data file was merged with local market area data obtained from the 1992 Area Resource File and with state level regulatory data. STUDY DESIGN: The likelihood of providing Alzheimer's Disease or subacute care in dedicated units was estimated by separate logistic regressions. PRINCIPAL FINDINGS: Results indicate that facilities with fewer Medicare patients are more likely to operate a dedicated Alzheimer's care unit, while facilities located in markets with a large HMO population and greater hospital supply are more likely to operate a subacute care unit. While competition among nursing homes, for the most part, is an incentive to innovate, greater regulatory stringency appears to constrain the development of specialty care units of both types. Finally, organizational characteristics (e.g., size and proprietary status) appear to be important enabling factors influencing the propensity to provide specialty care in dedicated units. CONCLUSIONS: Nursing care facilities are moving toward providing specialty care units partly as a response to a growing demand by resource providers and to maintain a competitive edge in tighter markets. Loosening regulation directed at cost containment would further encourage the development of specialty care but should be preceded by some evaluation of population needs for specialty care and the effectiveness of specialty care units.

Alzheimer Disease↗

PubMed1997

The evaluation of HIV counseling-and-testing services: making the most of limited resources.

The evaluation of HIV counseling, testing, referral, and partner notification (CTRPN) services are especially important given the rapid, relevant changes in counseling strategies, public policies, and testing technologies. Here we briefly review the important components of a comprehensive HIV CTRPN evaluation. However, resources for evaluation are usually quite limited, thus making comprehensive evaluations impossible. Yet even with limited resources, meaningful evaluative activities can be performed and some pressing evaluation questions answered. As an illustration, we present a practical evaluation project (conducted with limited resources) that assessed at a systems level the HIV counseling and testing (HIV CT) program in the state of Wisconsin. We describe how some of this evaluative information was utilized by the state's division of health.

AIDS Serodiagnosis↗

PubMed1998

[International comparisons of health care resources. Expenditure shared the GNP is inadequate. Complementary real measures are necessary].

Since the health care expenditure share of the GNP (gross national product) is a measure difficult to interpret, its use can yield erroneous results in comparing health care sector development in different countries. A complementary measure of health care resources is the size and structure of the health care labour force. Information from Sweden, Denmark, the United Kingdom and the USA shows that development in expenditure share of the GNP in no way reflects development in labour resources in the respective countries. Ranking of national costs differs depending on the measures used, which is partly to be explained by differences in relative prices in terms of various investment factors--e.g., salaries of qualified personnel. The generally slow wages trend in the Swedish health care sector is a contributory factor explaining why the marked increase in the labour force during the 1970s and 1980s is incompletely reflected in the health care expenditure share of the GNP. Studies of personnel resources at the hospital level in the above-mentioned countries have shown marked national differences to exist in terms of working hours, service contracts and job descriptions, which further explains the differences manifest at an aggregate level.

Costs and Cost Analysis↗

PubMed2005

Human resources for the control of road traffic injury.

The definition of the ideal numbers and distribution of human resources required for control of road traffic injury (RTI) is not as advanced as for other health problems. We can nonetheless identify functions that need to be addressed across the spectrum of injury control: surveillance; road safety (including infrastructure, vehicle design, and behaviour); and trauma care. Many low-cost strategies to improve these functions in low- or middle-income countries can be identified. For all these strategies, there is need for adequate institutional capacity, including funding, legal authority, and human resources. Several categories of human resources need to be developed: epidemiologists who can handle injury data, design surveillance systems, and undertake research; engineers and planners versed in safety aspects of road design, traffic flow, urban planning, and vehicle design; police and lawyers who understand the health impact of traffic law; clinicians who can develop cost-effective improvements in the entire system of trauma treatment; media experts to undertake effective behaviour change and social marketing; and economists to assist with cost-effectiveness evaluations. RTI control can be strengthened by enhancing such training in these disciplines, as well as encouraging retention of those who have the needed skills. Mechanisms to enhance collaboration between these different fields need to be promoted. Finally, the burden of RTI is borne disproportionately by the poor; in addition to technical issues, more profound equity issues must be addressed. This mandates that people from all professional backgrounds who work for RTI control should develop skills in advocacy and politics.

Accidents, Traffic↗

PubMed2000

Resource utilization and contaminated blood cultures in children at risk for occult bacteremia.

OBJECTIVE: To measure the increases in resource utilization and hospital charges associated with the evaluation of contaminated blood cultures obtained from emergency department patients at risk for occult bacteremia. DESIGN: Retrospective medical record review. SETTING: Emergency department of an urban, university-affiliated pediatric referral center. PATIENTS: Children aged 3 to 36 months with blood cultures positive for bacterial growth obtained between January 1994 and October 1996. MAIN OUTCOME MEASURES: Increased resource utilization related to contaminated blood culture follow-up, including telephone contact, return emergency department visits, additional diagnostic tests and therapies performed at reevaluation, and hospital admissions. Hospital charges for these additional services were tabulated. RESULTS: Of 8,306 children who had blood cultures drawn, 491 (5.9%) had positive findings. Four hundred eighty-five (98.8%) of these were available for review. Two hundred seventy-six (57%) of 485 were excluded from final analysis. Of the remaining 209 patients at risk for occult bacteremia, 85 (41%) had cultures that grew contaminants only. Follow-up of these 85 patients generated 106 telephone calls, 49 return visits to the emergency department, 102 additional diagnostic tests, 18 doses of parenteral antibiotics, and 12 hospital admissions with a combined length of stay of 24 days. This resulted in additional charges of $78,904, or an additional $642 per true pathogen recovered. CONCLUSIONS: Contaminated blood cultures obtained from children at risk for occult bacteremia lead to substantial increases in resource utilization and hospital charges. These untoward effects should be accounted for in formal decision analyses regarding the management of occult bacteremia.

Bacteremia↗

PubMed1995

On-line resources for pediatricians.

BACKGROUND: Medical information is increasingly available on computer networks. OBJECTIVES: To familiarize the pediatrician with some of the terms associated with these on-line resources, and to describe what is available via the Internet and dial-up computer bulletin boards. DATA SOURCES: Information for this article was taken from publicly available on-line services and Internet servers. DATA EXTRACTION: Only resources relevant to pediatric practice were included. DATA SYNTHESIS: Medical information on the Internet is in a state of evolution. Useful resources for pediatricians are sparse but expanding rapidly. CONCLUSIONS: Pediatricians may use on-line computer networks to communicate. Familiarity with computer networks will become more important to pediatricians as electronic medical records, on-line medical literature, and telemedicine (the practice of medicine over long distances) become more common. Medical libraries and commercial on-line services are good places to begin to investigate the availability of medical information over computer networks.

Computer Communication Networks↗

PubMed1997

The effect of payer status on utilization of hospital resources in trauma care.

OBJECTIVE: To determine the effect of payer status on outcome and resource utilization in motor vehicle-related trauma patients. DESIGN: Retrospective cohort analysis that assessed the effect of payer status on outcome and resource utilization. SETTING: The single level I trauma center in a regionalized statewide system. PATIENTS: Consecutive patients (N = 3141) who were hospitalized after a motor vehicle crash during a 3-year period. MAIN OUTCOME MEASURES: The mortality rate, disposition, total hospital length of stay (LOS), total intensive care unit LOS, and total hospital charges were examined for 2 categories of payers: "commercial insurance" (commercial, labor and industry, and contract pay) and "noncommercial insurance" (Medicaid and self-pay). RESULTS: After controlling for age, sex, race, and the Injury Severity Score, the payer status had no overall effect on the mortality rate, disposition, total hospital charges, total hospital LOS, or total intensive care unit LOS. However, there was a significantly (11.4%; P < .05) longer LOS for those patients with noncommercial insurance who required transfer to another facility for rehabilitation or long-term care. CONCLUSIONS: The utilization of hospital trauma care resources in a level I facility in a regionalized system was not associated with insurance status. Patients with noncommercial insurance who required transfer to elective long-term care facilities had a longer LOS due to delays in obtaining subsequent access. Health care policy should provide appropriate reimbursement for all aspects of regionalized trauma care systems to ensure maintenance of an egalitarian approach to care.

Accidents, Traffic↗

PubMed2004

Establishment of a pediatric oncology program and outcomes of childhood acute lymphoblastic leukemia in a resource-poor area.

CONTEXT: The cure rate for childhood acute lymphoblastic leukemia (ALL) differs markedly between developed and developing countries. OBJECTIVE: To assess the effect of a multidisciplinary team approach and protocol-based therapy on the event-free survival of children with ALL in an area with limited resources. DESIGN, POPULATION, AND SETTING: A retrospective cohort study at a pediatric hospital in the resource-poor city of Recife, Brazil. We reviewed medical records of the outcomes of 375 children with ALL diagnosed between 1980 and 2002. Eighty-three children were diagnosed in the early period (1980-1989), in the absence of a dedicated pediatric oncology unit, protocol-based therapy, specially trained nurses, 24-hour on-site physician coverage, and ready access to intensive care. Seventy-eight children were treated (all according to protocol) during the middle period (July 1994 to March 1997). During the recent period (April 1997 to December 2002), 214 children were treated with protocol in a dedicated pediatric oncology unit staffed 24 hours by pediatric oncologists and oncology nurses. Improvements were implemented gradually during the middle period and were completed during the recent period. MAIN OUTCOME MEASURE: Event-free survival was estimated by the Kaplan-Meier method. Events included death from toxicity, disease progression or relapse, and abandonment of treatment. RESULTS: The 5-year event-free survival improved steadily: 32% (95% CI, 21%-43%) in the early period, 47% (95% CI, 36%-58%) in the middle period, and 63% (95% CI, 55%-71%) in the recent period. The probability of cause-specific treatment failure in the early, middle, and late periods, respectively, within 1 year of diagnosis was 14% vs 3.8% vs 3.3% for relapse; 6.0% vs 12% vs 9.8% for death from infection; 2.4% vs 13% vs 4.2% for death from noninfectious toxicity; and 16% vs 1.3% vs 0.5% for abandonment of therapy. CONCLUSION: Treatment of childhood ALL in a dedicated pediatric oncology unit using a comprehensive multidisciplinary team approach, protocol-based therapy, and local support and funding is associated with improved outcomes in a resource-poor area.

Adolescent↗

PubMedDate not supplied

Health services reform and human resource management in Hong Kong public hospitals.

This article discusses the empirical study of reform in the human resource management function in the Hong Kong Hospital Authority. It describes the prior management of the hospitals based on the civil service administration model before looking at management reform in general. From this research, the creative tensions between the centrifugal and centripetal forces in the pursuit of 'effectiveness', 'efficiency' and 'economy' are explored in terms of decentralization. A survey of line managers, in eleven Hospital Authority hospitals, revealed the progress of decentralization: a majority of respondents felt that, over the previous five years, managers at their level had been given greater responsibility for human resource management issues. In spite of the widespread perception of increased decentralization, however, it was recognized that there are limits to decentralization. It was the routine administration rather than the policy formulation and interpretation which had been decentralized, and hospitals continued to rely on the Hospital Authority Head of Office for guidance on policy interpretation. Several barriers to the effective decentralization of responsibility for human resource management were identified, including a lack of management skill, knowledge and time, the attitudes of some managers and the tight control of budget.

Data Collection↗

PubMed1999

Integrating data for sustainable development: introducing the distribution of resources framework.

A complex, information-rich world requires frameworks that organize data to reveal succinct views and interrelationships. The goal of sustainable development requires a particularly large range of data covering many disciplines--economic, environmental, social and institutional. This paper introduces the Distribution of Resources (DOR) framework. DOR explicitly quantifies the changes in our natural and produced resources and traces the use of resources through production and consumption efficiency to distribution as welfare. The DOR framework accommodates many of the recognized concepts and principles of sustainable development resulting in a comprehensive policy-focused framework with a more extensive range of desirable features than other frameworks developed to date.

Data Interpretation, Statistical↗

PubMed2001

Bioinformatics for rice resources.

The distinguishing feature of the 'new biology' is that it is information intensive. Not only does it demand access to and assimilation of vast data sets accumulated by engineered laboratory processes, but it also demands a previously unimaginable level of data integration across data types and sources. There are various information resources available for rice. In addition, there are various information resources that are not focused on rice but that contain rice data. The challenge for rice researchers and breeders is to access this wealth of data meaningfully. This challenge will grow significantly as international efforts aimed at sequencing the entire rice genome come into full swing. Only through concerted efforts in bioinformatics will the power of these public data be brought to bear on the needs of rice researchers and breeders worldwide. These efforts will need to focus on two large but distinct areas: (1) development of an effective bioinformatics infrastructure (hardware systems, software systems, and software engineers and support staff) and (2) computational biology research in visualization and analysis of very large, complex data sets, such as those that will be developed using high-throughput expression technologies, large-scale insertional mutagenesis, and biochemical profiling of various types. In the midst of the large flow of high-throughput data that the international rice genome sequencing efforts will produce, it is also imperative that integration of those data with unique germplasm data held in trust by the CGIAR be a part of the informatics infrastructure. This paper will focus on the state of rice information resources, the needs of the rice community, and some proposed bioinformatics activities to support these needs.

Algorithms↗