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PubMed1999

Capitation or no capitation, hospitalist programs can pay off for hospitals.

A well run hospitalist program with sophisticated information and operational systems can reduce average length of stay by as much as 30% to 50% while actually improving care, according to. Michael Brouthers of Cogent Healthcare Inc., formerly Hospitalists, Inc. In an interview with Health Care Strategic Management, Brouthers discusses how a hospitalist program can benefit hospitals.

Capitation Fee↗
PubMed1999

[Factors which allow elderly persons living alone to continue living at home--analysis of the situation of elderly people living alone who are served by the Higashi Sapporo Hospital Home Care Support Center and Higashi Sapporo Visiting Nurse Station].

Amid the rapid ongoing shift from treating the elderly in hospitals to treating them at home, self-care by elderly people living alone is a serious and complicated problem. To investigate the support system that enables elderly living alone to maintain social independence and a high quality of life at home, the main factors which allow the person to continue living at home were sought through an analysis of the current situations of 44 elderly-persons living alone, who use the services of our home care support center and visiting nurse station. From this analysis, the elderly person who continue to live alone at home were ranked from J-A for degree of independence in daily life, and the degree of independence of in daily life of elderly suffering from dementia was normal rank I and II. It was also found that such people use multiple services and that their health is stable. In the future it will be necessary to develop systems and networks which function to coordinate multiple services and make possible the smooth transition between home and hospital or institution. The practice of informed consent must also be improved. Finally, it will be important to promote the appropriate management of disease and local rehabilitation services.

Activities of Daily Living↗
PubMed1999

Et Tu, Counselor: may an in-house attorney file a qui tam action against the attorney's employer?

Most corporations probably do not consider their in-house counsel to be potential qui tam threats. That may be a naive assumption. Case law provides an illustrative view of the legal ramifications involved when an attorney brings a qui tam suit. In general, there is no prohibition on attorneys who wish to bring these actions. Nevertheless, a corporation can take preventive steps to eliminate the likelihood of attorney qui tam actions. In addition, the corporation can take advantage of state professional ethics laws to mount a defensive action against the attorney who files any such action.

Confidentiality↗
PubMed1999

Staffing issues at open-heart centers offering both pediatric and adult perfusion service: 1998 survey results.

A survey directed to centers offering both pediatric and adult perfusion services was conducted to determine how pediatric cases were distributed among individual perfusionists in their departments. These centers were also asked what they believed the clinical activity level should be for a perfusionist each year to remain proficient in pediatric cardiopulmonary bypass. The questions were asked via e-mail and then followed up with telephone interviews as necessary. Out of the 100 centers contacted, 45 responded to the survey (43 North American, 2 European). Of the forty-five centers, forty-one provided both pediatric and adult perfusion services. Thirty-two centers (78%) offering adult as well as pediatric perfusion services distributed the pediatric caseload to a select group of perfusionists. Nine centers (22%) distributed the pediatric open-heart caseload to the entire staff. From the respondents, the average minimum number of pediatric cases believed necessary to remain proficient in pediatric perfusion was 42.8 cases annually. Centers having dedicated pediatric perfusionists had a slightly higher annual caseload than did those at non-specialized centers, despite practicing at institutions averaging fewer pediatric open-heart cases annually.

Adult↗
PubMed1999

Health technology assessment and the regulation of medical devices and procedures in Quebec. Synergy, collusion, or collision?

In this paper, we discuss the complex relationship between health technology assessment (HTA) and the regulation of medical devices and procedures. The relationship is first examined through a conceptual framework describing the itinerary from research to three levels of policy making: micro (standards of medical practice), meso (institutional rules), and macro (health policies). Four reports from the Quebec Health Technology Assessment Council (CETS) are used to illustrate how HTA activities can influence the regulatory mechanisms operating at each decision-making level. We then discuss the skillful balancing act required from HTA agencies to constantly negotiate the right distance from the regulatory process at which to operate. We propose that HTA agencies should not be incorporated into any regulatory, auditing, or monitoring process. Finally, the relationship between health technology assessment and health care reform is discussed. It is suggested that HTA activities will contribute most during the data-driven preparation and consolidation phases of a reform process. The fast pace of events and the political turmoil characteristic of the implementation phase provide a less receptive environment for HTA contributions.

Equipment and Supplies↗
PubMedDate not supplied

Potential reduction in mortality rates using an intensivist model to manage intensive care units.

CONTEXT: Because of evidence suggesting that outcomes are better in "intensivist-model" intensive care units (ICUs), the Leapfrog Group's hospital safety standards propose that ICUs be managed by critical care physicians (intensivists) who work exclusively in the ICU. COUNT: Number of lives saved annually in the United States. CALCULATION: Lives saved = (number of ICU admissions x in-hospital mortality rate of ICU patients) x reduction in mortality rates associated with the intensivist model. DATA SOURCE: Reduction in mortality rate associated with intensivist-model ICUs was determined by performing a structured literature review from 1986 to the present using MEDLINE. Other variables were estimated from various data sources. RESULTS: In the nine studies that met our selection criteria, relative reductions in mortality rates associated with intensivist-model ICUs ranged from 15% to 60%. On the basis of the most conservative estimate of effectiveness (15% reduction), full implementation of intensivist-model ICUs would save approximately 53,850 lives each year in the United States. CAUTIONS: Given the large number of ICU patients and their high baseline risks, even modest reductions in mortality rates would save many lives. Because of potential constraints related to the workforce and other resources, the feasibility of fully implementing intensivist-model ICUs nationwide is uncertain.

Health Services Research↗