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At least 19 recordsLinked to original sources
PubMed1975

Capital expenditures and the availability of funds.

Data on capital expenditures and the availability of funds assembled from the annual financial and service records of 42 short-term voluntary hospitals in New York City over two decades were used to analyze the behavior of annual capital expenditures on building and equipment assets. Desired expenditures on capital as a factor of production are viewed as being the result of changes in anticipated output and of the substitution of capital for labor. Actual capital expenditures in each year also reflect the availability of flows of nonoperating revenues and the completion of capital programs initiated in previous years. Nonoperating revenues include philanthropy and earnings on financial assets as principal sources. A monetary revenue series, adjusted for changes in hospital charges, was used to measure output and thus to seperate the effects of demand for hospital services and supply of funds on investment behavior. The data were approached as annual aggregates for 42 hospitals over the years 1946-1966 and as annual hospital averages for teaching and nonteaching hospitals over the same period. In both approaches four causal factors-output, substitution, the flow of nonoperating revenues, and a distributed lag-explained about 95 per cent of the sample variance of capital expenditures. Allowing for available funds reduced the average time required for 95 per cent completion of a capital adjustment from 7 to 3 years. Responsiveness of hospitals to these economic variables suggests that socially desired investment can be attained by (a) "monetizing" needs of groups now underserved; (b) improving availability of funds if used for acceptable public purposes; and (c) including consumers in determining institutional and regional priorities.

Charities↗
PubMed1979

Homes or hospitals? Contradictions of the urban crisis.

Medical expansion is threatening to eliminate many urban residential areas, despite criticisim that argues for comprehensive planning, reduced costs, less concentrated power in the health sector, and a reversal of "medicalization." Our research on expansion, which grew partly from personal participation in a local struggle against expanding institutions in Boston, revealed certain tensions in combining sociomedical research with concrete political practice. From events in Boston and from an exploratory review of periodicals, we recognized that medical expansion and community conflict occur frequently in cities throughtout the United States. Based on general theoretical perspectives from organizational analysis and political economy, we made several hypotheses that we tested through a questionnaire sent to all hospitals in the 20 largest cities of the United States and through other data available on the same hospitals. In large part, this empirical study confirmed our theoretical expectations that (a) larger medical centers show a greater tendency toward territorial growth than smaller hospitals; (b) bureaucratic and administrative dynamics lead to facilities that do not necessarily enhance patient care; (c) despite short-term cycles of expansion and contraction in public hospital growth, expansion projects are widespread and generate considerable political conflict; (d) because of the state's contradictory roles in regulation and social capital expenditures, opposition to medical expansion comes more from community organizations than from governmental monitoring or planning bodies; and (e) the needs of capital determine that medical expansion has a more detrimental impact on housing than on commercial or industrial facilities. Future expansion of private medical facilities is more likely than that of public facilities, although much private expansion may receive public subsidization. As ideologic patterns are demystified, the contradictions between medical expansion and housing needs can provide a focus for successful community organizing.

Boston↗
PubMed1975

Implications of certificate of need legislation for institutional pharmacy practice.

Federal certificate of need legislation (Section 1122 of Public Law 92-603)aimed at the elimination of costly, duplicative or unneeded health care expenditures is discussed. This law applies only to institutional providers receiving federal reimbursements. The key issues for pharmacy are that proposed substantial changes in service and capital expenditures of $100,000 or more must be justified to local and state comprehensive planning agencies prior to implentation. Failure to comply with the legislation can result in a reduction or withholding of federal reimbursement.

Costs and Cost Analysis↗
PubMed1990

Clinical laboratory management: a critical evaluation.

The clinical laboratory is described as a system with an enquiry component or demand side, where control of test utilization is the mandate of the clinical physician or surgeon, and a production component or supply side, where answers to clinical questions are generated and control of test data production is the mandate of the laboratory physician. Supply side unit costs are maintained by increased production effectiveness brought about by the judicious manipulation of supply costs; labor costs; and capital expenditures for automated equipment, robots, and information technologies. The pathologist's prime role as controller of the supply side is outlined, as are the clinical physician's prime role and pathologist's subsidiary role in control of test use on the demand side.

Capital Financing↗
PubMed1989

Laparoscopic treatment of polycystic ovarian syndrome.

Laparoscopic techniques show a number of advantages in comparison with the classic ovarian wedge resection for the treatment of PCOD. An equally high ovulation rate is achieved with less trauma, and fewer postoperative adhesions result in a higher pregnancy rate. The procedure may be done on an outpatient basis with reduced operative and recovery time. No clear advantages have so far been shown to exist for any of the available techniques, i.e. laparoscopic biopsy, electrocautery, and the four laser systems (CO2, Nd-YAG, argon, KTP). It appears, however, that the laser techniques will be the methods of choice for the future. They combine optimal precision of operation handling with maximal safety and excellent bleeding control. With laparoscopic biopsy traumatic bleedings may occur, which can occasionally be difficult to control. With electrocautery, burns due to the uncontrolled effect of electric current have been described. Optimal application of the laser techniques requires extensive personnel training and experience. The laser equipment requires considerable capital expenditure of the order of 20,000-70,000 pounds. The exact mechanism by which induction of ovulation and regular cycles are induced is yet unknown. Alteration of the ovarian surface including the underlying tissue particularly the atretic follicles leads to a significant postoperative change of the pathophysiological mechanism. The following factors are postulated to be responsible for postoperative ovulation: 1. The drainage of the follicular fluid which contains high androgen levels results in an acute reduction of the intraovarian androgen level. 2. With coagulation and/or vaporization of the atretic follicles androgen production is significantly limited. 3. This localized reduction of androgen decreases their inhibitory effect on follicular maturation. 4. Lowered androgen levels result in diminished peripheral conversion of androgen to oestrogen and decreased positive feedback on LH production. 5. The secondary reduction of ovarian inhibin permits a rise of FSH secretion which results in a normal LH:FSH ratio.

Electrocoagulation↗
PubMed1990

Large loop excision of the transformation zone (LLETZ) compared to carbon dioxide laser in the treatment of CIN: a superior mode of treatment.

A series of 199 patients with histologically confirmed cervical intraepithelial neoplasia (CIN) grade II or III were allocated by hospital number to receive out-patient treatment by carbon dioxide laser vaporization or large loop excision of the transformation zone (LLETZ). All patients received local anaesthesia. The women in the LLETZ group experienced less post operative haemorrhage, less discomfort, operative time was greatly reduced, and histological material was available for confirmation of the diagnosis. There was no significant difference in recurrence of CIN after treatment between the two groups. At 6 month follow-up, recurrence rates of 8.2% (CIN II) and 7.5% (CIN III) were observed in the laser-group and 5% (CIN II) and 5.3% (CIN III) in the LLETZ group. Further advantages of LLETZ are reduced capital expenditure and no hazard to the eyesight of the surgeon, but laser treatment is preferable in patients with widespread vaginal involvement.

Adolescent↗
PubMed1991

Words without action? The production, dissemination, and impact of consensus recommendations.

When existing evaluations find little or no evidence of consensus recommendations leading to action, one can justifiably ask why so much of this review was dedicated to analyzing alternative ways of producing such "words without action." There are, however, at least two reasons why consensus recommendations should be produced with care and attention to validity. First, recommendations do sometimes have an impact on behavior as a consequence of mere dissemination activity--the Dutch program, for instance, was more successful than most. This success may occur when the target audience is already particularly receptive to change and the message is timely and delivered by a credible source in a clinically relevant way. Thus, although "such a conjunction of favorable conditions is probably the exception rather than the rule for consensus topics" (46, 240) it does happen. Second, the output from consensus processes is increasingly a potential input to other processes. Consensus recommendations can be used as the criteria for evaluation and appraisal aimed at changing practice behavior, making administrative decisions on resource allocation, or defining research protocols. For instance, quality assurance activities, such as peer assessment, practitioner certification, or utilization review, are actively seeking criteria with which to make judgments and elicit changes in practice to improve the quality of care. Funding agencies are looking for information to help make reimbursement, capital expenditure, or fee-for-service decisions on cessation of insurance for particular procedures or approaches. These uses of the consensus criteria are potentially major and controversial. Therefore, even if dissemination rarely leads to action, consensus processes should still be done carefully and with valid techniques. The use of their recommendations embedded within other activities may well lead to (forced) changes in behavior. On ethical grounds alone, we should be as sure as possible that the behavior changes being implied and encouraged are indeed advisable. For these reasons, the review describes the decision points in the production process for consensus recommendations as a start on the development of a set of recognized standards. The review offers a critical appraisal of the various methodological choices available at each decision point. The seven decision points are selecting a topic, picking the consensus group, providing background preparation, identifying information inputs, choosing a group judgment process, defining the criteria for recommendations, and choosing a report preparation procedure and format. At least two important points emerged from this review. First, the research is often not well enough developed to give clear indications for many of the choices on what is the "best" alternative.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗
PubMed1990

Therapeutic drug monitoring analysis systems for the physician office laboratory: a review of the literature.

Commercially available systems for therapeutic drug monitoring in the physician office laboratory (POL) are reviewed. The Abbott Vision, Kodak Ektachem, Syntex AccuLevel, Syva Emit QST, Ames Seralyzer ARIS, and Ames Clinimate ARIS have been found to be sensitive and accurate compared with more conventional laboratory assays, and are well-suited for the POL. The number of available drug assay is very limited with every system except the QST. The QST offers a large menu and would be appropriate for large practices. The Abbott TDx or other semiautomated system usually found in the clinical chemistry laboratory may be particularly useful and cost-effective in office practices with a large volume of specimens. AccuLevel or ARIS might be the best choices for clinics or pharmacies that generate few samples. The start-up time is the longest with the Vision and Ektachem systems (30 minutes). Most systems have the capacity to produce results within one to five minutes with the exceptions of the Vision (13 minutes for theophylline) and AccuLevel (20 minutes). The Vision is the most automated system and both AccuLevel and the Vision use whole blood, thereby bypassing the additional time required for centrifugation of the patient specimen. The Ektachem, Vision, and QST have an operator-independent pipetting step that offers a significant advantage when operated by semiskilled personnel. Although the AccuLevel eliminates the need for a large initial capital expenditure, the individual cost per test is higher. Leasing programs are available or certain systems. Increased government regulation will improve the quality control of therapeutic drug monitoring in the POL.

Clinical Laboratory Techniques↗
PubMed1992

Laser technology planning.

Lasers continue to be a highly useful and important surgical tool, and, in today's competitive healthcare environment, they are also an effective marketing tool. The public perceives lasers to be "high-tech" instruments, associating them with excellence of care. And the availability of state-of-the-art equipment such as lasers is often critical to medical staff recruitment. However, lasers are not universal surgical tools, as some proponents suggest. They are costly, and other less expensive technologies are acceptable and sometimes more desirable for certain procedures. Also, marketing reasons alone cannot justify laser acquisition. Faced with new, more restrictive federal regulations for Medicare reimbursement of capital expenses, hospitals need effective technology planning more than ever, particularly when planning for such "high-ticket" items as lasers. They can no longer afford to acquire lasers based on the perceptions of the public or the demands of one or even a few physicians; poor planning in the past has caused many new lasers to collect dust from low utilization. (ECRI's 1991 user survey on general-purpose surgical lasers found that, on average, hospitals use lasers in less than 5% of their total surgical procedures.) Hospitals need to approach the acquisition of laser technology cautiously to ensure that the appropriate equipment is obtained, that it will be well utilized for procedures in which it offers a demonstrable improvement over alternative technologies, and that it will also conform to the overall strategic plan of the institution. The purpose of this article is to provide guidance on the technology acquisition process, whether a hospital is acquiring its first laser or has a well-established laser program.(ABSTRACT TRUNCATED AT 250 WORDS)

Capital Expenditures↗
PubMed1992

Survey: equipment budgets up; use in outpatient areas growing.

Most hospitals increased their capital equipment budgets this year, finds a new survey sponsored by Hospitals and the Linc Group Inc. Rather than adding new services, hospitals are replacing equipment. But they remain cautious about adding new services, experts note.

Budgets↗