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At least 19 recordsLinked to original sources
PubMed1990

Procedure-specific costs and savings in a mandatory program for second opinion on surgery.

Initial examination of the surgery experience of participants in a large employer-sponsored second opinion program revealed minimal savings in medical resource costs. But closer examination of relative savings for specific procedure categories showed that the greatest savings are for high-cost procedures: hysterectomy, prostatectomy, back surgery, and hip replacement. Furthermore, a nonconfirming second opinion does not dissuade patients from some procedures. Decisions about which procedures to include in a mandatory program should consider volume, costs, and effects of nonconfirmation, as well as the advantages of a mandatory second opinion for skeptical patients, or for patients for whom a controversial procedure has been recommended.

Blue Cross Blue Shield Insurance Plans↗
PubMed1999

Medicare and Medicaid programs; mandatory use, collection, encoding, and transmission of Outcome and Assessment Information Set (OASIS) for home health agencies. Health Care Financing Administration (HCFA), HHS. Notice.

This notice announces to home health agencies (HHAs), State survey agencies, Medicare and Medicaid beneficiaries, software vendors, and the general public changes to and effective dates for OASIS implementation. This notice announces the effective dates for the mandatory use, collection, encoding, and transmission of OASIS data for all Medicare/Medicaid patients receiving skilled services. For non-Medicare/non-Medicaid patients receiving skilled services, there will be no encoding and transmission until further notice, but HHAs must conduct comprehensive assessments and updates at the required time points. For patients receiving personal care only services, regardless of payor source, we are delaying the requirements regarding OASIS use, collection, encoding, and transmission until further notice. We expect to begin implementation of OASIS for non-Medicare/non-Medicaid patients receiving skilled care and for patients receiving personal care only services in the Spring of 2000. A separate Federal Register notice will be published with instructions at that time. In addition, software changes described at the end of this notice are of interest to software vendors and HHAs. Also, a companion notice concerning the OASIS System of Records (SOR) is published elsewhere in this Federal Register and is available via the HCFA Internet site (http://www.hcfa.gov).

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

A creative safety program.

Mandatory safety programs can be creative and fun using the instructional game approach. Games can be completed on the patient care unit when a free moment is available. Once the instructional games are developed, they can be used throughout the year to help the staff review safety policies, procedures, and standards.

Accident Prevention↗
PubMed2005

[Tuberculosis and human rights].

Tuberculosis (TB) patients must be hospitalized while the smear of sputum is positive because TB spreads through air. Cooperation of a patient is important in order to complete the treatment of TB. However, a small number of patients are noncooperative for the treatment and may sometimes refuse it. At this symposium, we discussed about whether we could restrict the human rights of noncooperative TB patients. Although the patients' human rights must be protected, we also have to protect the human rights of people who may receive TB infection. The balance of the both people's rights is fully considered in the TB control policy. It is epoch-making that the TB society took up the theme about the human rights' restriction of TB patients. Five speakers presented their papers from each position. There were presentations about the scientific evidence of isolation, the actual cases, the situation of the United States, and the legal view on the human rights' restriction of TB patients. The present situation and the legal problems in Japan became clear at this symposium. We need further discussion about the human rights' restriction of TB patients for the revision of the Tuberculosis Protection Act and have to obtain the national consensus on it. 1. The evidence for isolation: Emiko TOYODA (International Medical Center of Japan) To determine appropriate periods of respiratory isolation, available biological, clinical, and epidemiological issues and data were studied. Although absolute lack of infectiousness requires consecutive culture negative and it takes too long and impractical periods. There seems to be no established evidence for noncontagiousness after 2 to 3 weeks effective treatment. Practically conversion to 3 negative consecutive smear results may used as a surrogate for noninfectiousness, even though a small risk of transmission still be present. Chemical isolation has been more important and administration with DOT should be indicated to keep compliance. 2. Discontinued hospitalization in tuberculosis patient: Yoshiko KAWABE (National Hospital Organization Tokyo National Hospital) We investigated the background of tuberculosis patients who entered our hospital in 11 years from 1993 to 2003 and discontinued hospitalization. Out of 4,126 cases 76 cases (1.8 %) discontinued hospitalization. We classify three groups. One is self discharged group who leaved hospital without permission. Second is obligatory discharged group who were displaced for some trouble. Third is transferred group who were transferred to another hospital including mental hospital that have ward for tuberculosis. Major reasons were drinking during hospitalization, violence, roam because of dementia and major backgrounds were repeatedly noncompliant patients, homeless people, and suffering from senile dementia. We concluded we need some legal intervention for few cases who cannot continue hospitalization. 3. Tuberculosis control policy and human rights in public health center: Keiko FUJIWARA (Infection Diseases Control Division, Public Health Bureau, City of Yokohama) It is required for a success of the tuberculosis control policy to consider human rights. Patients' human rights should be respected, and surrounding people's human rights should also be respected. We sometimes see a tuberculosis patient who cannot continue tuberculosis treatment. A society as a whole has to share the recognition of tuberculosis as a social illness. The completion of tuberculosis treatment is not only the benefit of individual, but also it is very important as social defense. When we revise the tuberculosis control policy, we should think about both protecting a society from tuberculosis and protecting tuberculosis patients' human rights and obtain national consensus. 4. The mandatory TB control policy in the US: Hidenori MASUYAMA (Shibuya Dispensary, Japan Anti-TB Association) The mandatory TB control policy in the US was discussed. If the mandatory health policy would be applied, the following three criteria of human rights must be satisfied. 1. The health of others will be adversely affected without a mandatory program. 2. The mandatory program is the least restrictive alternative. 3. The mandatory program is implemented equitably without purposeful bias. For example, the mandatory DOT could not satisfy these criteria. Before applying the mandatory TB control policy in Japan, the TB patient's autonomy and social cooperation of TB therapy need to be considered. 5. Tuberculosis and guarantee of human rights: Shigeru TAKAHASHI (Graduate School of Law, Hitotsubashi University) In modern administrative Law the relations between Governments and peoples are regarded not as the facing relationships between Governments and the peoples, who submit to the interventions by Government, but as the triangle relationships between Governments, the peoples who submit to the interventions by Governments and the peoples who enjoy benefits from the interventions by Governments. When we make a new design of the Tuberculosis Protection Act, we must at first take considerations of the human rights of the tuberculosis patients from the view points of due Process of Law. And we must also take considerations of the human rights of the peoples who are threatened with the risks of tuberculosis infection.

Adult↗
PubMed2005

Integrating simulation into a busy residency program.

A mandatory program of computer-driven simulation training was instituted in a medium-sized surgical training program in order to achieve the goal of increased resident performance outside the setting of direct patient care. Postgraduate year (PGY) 1-5 residents received mentored instruction on a virtual reality (VR) laparoscopic surgical trainer in performance of specific tasks appropriate to training level. Training for PGY 1-2 residents consisted of basic manipulative VR tasks. Training for PGY 3-5 residents consisted of VR suturing and intracorporeal knot-tying tasks. Each resident received two to four mentored one-hour sessions, and was instructed to return for self-directed practice during blocked and unscheduled time. PGY 3-5 residents had laparoscopic suturing and knot-tying skills evaluated in an animal model prior to onset of VR training and two to four months after start of training. After seven months of availability of training, PGY 1-2 residents had undertaken significantly more training sessions than PGY 3-5 residents (18+/-3 vs. 9+/-2; p<0.01). All PGY 1-2 residents demonstrated improved task performance, and six achieved expert performance relative to experienced laparoscopic surgeons. The suturing task in the animal lab was accomplished faster post-training (91+/-9 seconds vs. 154+/-16 seconds; p<0.01). Early results suggest that broadly applied VR training is of significant benefit in increasing resident technical skills. Based on early success, a broader program of computer-based simulation has been implemented, using more advanced devices for technical skills training, and a human patient simulator for training critical decision-making skills.

Journal Article↗
PubMed2006

The California Cardiac Surgery and Intervention Project: evolution of a public reporting program.

Mandatory public reporting of cardiac surgery outcomes in California was instituted in 2003. To study the impact of the program, the outcomes of coronary artery bypass graft (CABG), valve, and percutaneous coronary intervention (PCI) procedures performed after January 1, 2003 were compared with previous years using the Patient Discharge Database (PDD) of the Office of Statewide Health Planning and Development. Risk-adjusted in-hospital mortality for CABG, CABG plus valve or aneurysm, and valve procedures decreased during 2003 and 2004 compared with 1998 through 2002, and PCI mortality remained unchanged. The average annual procedural volume per hospital decreased 25 per cent (232% +/- 205% to 173% +/- 157%) for CABG and 18 per cent (310% +/- 278% to 253% +/- 235%) for all cardiac surgeries, whereas PCI increased 12 per cent (433% +/- 277% to 492% +/- 356%). During 2003 and 2004, less than one-half of the 120 hospitals performed 200 or more cardiac surgeries per year, and only 25 performed 300 or more. Higher CABG mortality was observed primarily in low-volume programs, but the relationship of volume to risk-adjusted mortality was not significant for any surgical group or for PCI. Identification of outlier status was facilitated by use of 30-day posthospital outcomes (death or reoperation) in addition to in-hospital mortality. This study suggests that the introduction of a mandatory cardiac surgery reporting program in California was associated with improved outcomes.

Angioplasty, Balloon, Coronary↗
PubMed2006

What do dental students think about mandatory laptop programs?

In spite of efforts by many dental schools to provide information technology resources for students, only a handful of studies have been conducted to determine what dental students think about these initiatives. There are no reports in the literature describing students' perceptions of mandatory laptop programs, which are now being implemented by at least 25 percent of North American dental schools. In schools that have implemented laptop programs, students are required either to enroll with their own laptops that meet specifications or to purchase a laptop from the school at matriculation. In some schools, students are also required to purchase curriculum support software that is bundled with the laptop. This study was conducted to determine students' opinions at U.S. dental schools with mandatory laptop programs about these aspects of this information technology initiative: frequency of use, perceived necessity of use, note-typing during lectures, effectiveness of training, influence on study habits, benefits, implementation problems, added value in relation to added tuition costs, impact on quality of dental education, overall rating of the laptop experience, and impact of the laptop on use of other electronic curriculum resources. Responses of students at schools that purchased packaged curriculum support software from a commercial vendor were compared with students' responses at schools where faculty provided their own educational software. Responses were also compared among freshmen, sophomores, and upperclassmen in a cross-sectional sample. In 2004, approximately 800 dental students at fourteen dental schools responded to eleven questions that requested their impressions and evaluation of mandatory laptop programs and associated educational software. These questions comprised one section of the IREC Students' Questionnaire (IREC=Institutional Readiness for Electronic Curriculum) that assessed students' perceptions of various aspects of information technology at their schools. The majority of students (63 percent) reported that the laptop and associated software were not essential for successful performance in their courses primarily because few instructors had modified their courses to take advantage of laptop capacities. Slightly more than half of the students reported their training was good or excellent, but felt that classroom-based "one size fits all" training was not effective. Less than 15 percent of the students reported that they had made substantial changes in their study habits as a consequence of the laptop program. The benefits perceived by students were primarily related to enhanced email communication with classmates and instructors and convenient access to the Internet and teachers' PowerPoint presentations. Implementation barriers included the inconvenience of carrying laptops to classes, lack of incentive to use the laptop and software because instructors did not require it, and poor quality software. Only 32 percent of students agreed that the value of the laptop and associated software was equal to the added tuition costs. Less than half of the students perceived that the laptop and software had improved the quality of their education, but more than 70 percent rated their overall experiences with laptops as "okay," "good," or "excellent." Freshmen expressed significantly more positive attitudes about the frequency of use, cost-effectiveness, educational value, and overall quality of laptops and bundled software than did upperclassmen. A significantly higher percentage of students at schools affiliated with a software vendor reported that laptops were essential in courses than students at schools with locally produced software, but students at vendor-supplied schools rated the cost-effectiveness significantly lower. Overall, students' assessment of mandatory laptop programs was mixed although freshmen provided significantly more positive responses than did upperclassmen. Incorporation of the e-curriculum into dental schools appears to be following a similar pattern as problem-based learning (PBL) in the 1980s and 1990s. Recommendations for enhancing future e-curricula are proposed based on lessons learned from both information technology and PBL implementation.

Adult↗
PubMedDate not supplied

Self-learning packages in staff development.

Potential uses for self-learning packages in the nursing staff development setting include orientation programs, mandatory education programs, developmental programs, and review of infrequently used skills. The staff development educator can use pretest and posttest results obtained from the use of self-learning packages to document intervention with the learner. Benefits for both learners and staff development educators when this teaching strategy is used are described.

Education, Nursing, Continuing↗
PubMed1990

Cardiopulmonary resuscitation: a mandatory training program for nursing staff.

At Flinders Medical Centre, a 600 bed teaching hospital in Adelaide, South Australia, there are between eighty and one hundred cardiac arrests in the general wards areas each year. From the time an arrest occurs until the arrest team arrives, the patient's life will depend on the speed with which Cardiopulmonary Resuscitation (CPR) is initiated and the effectiveness of the CPR performed by ward staff. The outcome of cardiac arrest patients who receive promptly administered CPR is extensively documented in literature on the subject. When an arrest occurs in the ward at Flinders, staff activate an emergency call to the "cardiac arrest team", which consists of three medical staff members and one nursing staff member. The nurse, from the Intensive Care Unit, is responsible for coordinating the actions of the nursing staff during the arrest. Following the arrest an audit sheet is completed with details of the patient, the arrest, treatment, and any other pertinent information. Until 1985 it was not unusual at Flinders for arrest audit sheets to have comments such as: "CPR not performed by ward staff" or "CPR not being performed correctly by ward staff" or, even worse, "Ward staff disappeared when the arrest team arrived". In many hospitals throughout Australia this was, and may still be, a familiar problem. The nursing department at Flinders believed that if a program could be established in which nurses were given the opportunity to learn and practise CPR, they could gain the skills necessary to perform basic CPR in the ward until the arrest team arrived. In 1985 a coordinator of such a program was appointed, and it became mandatory at Flinders for all nursing staff to learn and be accredited annually in basic CPR skills. This article describes how the CPR Program started, its progress, and its results.

Cardiopulmonary Resuscitation↗
PubMed1997

Using a performance improvement team to reinvent a mandatory education program.

BACKGROUND: To improve employee attendance at Annual Review Day, the day when all mandatory hospitalwide education requirements are presented. The Finley Hospital (Dubuque, Iowa) initiated a performance improvement team in March 1993. Data collected previous to 1993 indicated that the compliance goal of 90% was being met only with difficulty. PERFORMANCE IMPROVEMENT TEAM: Data indicated three main areas where improvements could be made-communication, enforcement, and curriculum. Recommendations of task forces, with team members as leaders, were implemented. Decisions were made to change Annual Review Day to a full-day format to include all mandatory education, make outcomes competency based, and maintain cost-effectiveness. TRIAL RUN AND EVALUATION: The one-year trial run began in 1994 with gradual changes in the program from a lecture and video format to an interactive game format. For example, at one point a crossword puzzle with information on infection control and bloodborne pathogens was added. The Jeopardy Game format, used to teach the principles of emergency preparedness, was added in June 1994. Full implementation of the curriculum, communication, and enforcement recommendations have resulted in 100% compliance. MAINTAINING THE GAIN: The performance improvement team has continued to monitor results and submit quarterly reports to the quality management department. All participants must complete and pass a competency-based test on the information covered; all 760 participants have passed. The curriculum task force continues to meet on a yearly basis to evaluate the ever-evolving format, analyze attendee evaluations, and consider annual changes to the format.

Accreditation↗
PubMedDate not supplied

Using healthy life years (HeaLYs) to assess programming needs in a public health unit.

In December 1997, public health units in Ontario received revised mandatory program guidelines from the Ministry of Health in advance of the downloading of public health to municipalities. Public health units face difficult decisions in allocating municipal resources to meet the Province's mandated programs. To set priorities for resource allocation, it is critical to assess need across program areas and to use a common unit in doing so. This paper applies the Healthy Life Years (HeaLYs) method in assessing health need related to the mandatory programs for the population of Wellington and Dufferin counties in Ontario. The HeaLYs method incorporates duration and severity of ill-health, incidence and mortality in calculating years of healthy life lost (YHLL). For Wellington-Dufferin, the leading causes of YHLL were concentrated in the program areas of chronic disease, injury, and substance abuse and included four areas not addressed in the MPG (suicide, depression, dementia, and osteoarthritis).

Adult↗
PubMed2003

Effects of Medicaid managed care programs on health services access and use.

OBJECTIVE: To estimate the effects of Medicaid managed care (MMC) programs on Medicaid enrollees' access to and use of health care services at the national level. DATA SOURCES/STUDY SETTING: 1991-1995 National Health Interview Surveys (NHIS) and a 1998 Urban Institute survey on state Medicaid managed care programs. STUDY DESIGN: Using multivariate regression models, we estimated the effect of living in a county with an MMC program on several access and use measures for nonelderly women who receive Medicaid through AFDC and child Medicaid recipients. We focus on mandatory programs and estimate separate effects for primary care case management (PCCM) programs, health maintenance organization (HMO) programs, and mixed PCCM/HMO programs, relative to fee-for-service (FFS) Medicaid. We control for individual and county characteristics, and state and year effects. DATA COLLECTION/EXTRACTION METHOD: This study uses pooled individual-level data from up to five years of the NHIS (1991-1995), linked to information on Medicaid managed care characteristics at the county level from the 1998 MMC survey. PRINCIPAL FINDINGS: We find virtually no effects of mandatory PCCM programs. For women, mandatory HMO programs reduce some types of non-emergency room (ER) use, and increase reported unmet need for medical care. The PCCM/HMO programs increase access, but had no effects on use. For children, mandatory HMO programs reduce ER visits, and increase the use of specialists. The PCCM/HMO programs reduce ER visits, while increasing other types of use and access. CONCLUSIONS: Mandatory PCCM/HMO programs improved access and utilization relative to traditional FFS Medicaid, primarily for children. Mandatory HMO programs caused some access problems for women.

Adult↗
PubMed1981

An analysis of the effects of prospective reimbursement programs on hospital expenditures.

Prospective reimbursement (PR) programs attempt to restrain increases in hospital expenditures by establishing, in advance of a hospital's fiscal year, limits on the reimbursement the hospital will receive for the services it provides to patients. We used data complied from a sample of approximately 2700 community hospitals in the U.S. for each year from 1969 to 1978 to estimate the effects of prospective reimbursement programs on hospital expenditures per patient day, per admission, and, to a lesser extent, per capita. The statistical evidence indicates that some PR programs have been successful in reducing hospital expenditures per patient day, per admission, and per capita. Eight programs--in Arizona, Connecticut, Maryland, Massachusetts, Minnesota, New Jersey, New York, and Rhode Island--have reduced the rate of increase in expenses by 2 percentage points or more per year and, in some cases, by as much as 4 to 6 percentage points. There are indications, although less strong, that PR programs also reduced expenses in Indiana, Kentucky, Washington, western Pennsylvania, and Wisconsin. There are no indications of cost reductions for programs in Colorado and Nebraska. An analysis of the relative effectiveness of the various programs suggests that mandatory programs have a significantly higher probability of influencing hospital behavior than do voluntary programs. Some voluntary programs, however, are shown to be effective.

Analysis of Variance↗
PubMed1980

Second opinions for elective surgery. The mandatory medicaid program in Massachusetts.

In 1977, Massachusetts implemented a requirement that Medicaid recipients obtain a second surgical opinion before elective surgery. Using consultants' reports and surveys, we assessed the initial year's results in metropolitan Boston. Of 2060 Medicaid patients originally advised to undergo one of eight elective surgical procedures, 1591 (77.2 per cent) participated in the mandatory second-opinion consultation program, 10.5 per cent received approval for surgery without a second opinion because of clear indications such as cancer, and 12.3 per cent did not keep or accept appointments for a second opinion. Of the 1591 patients who participated, 88.7 per cent were given second opinions in favor of surgery, and 11.3 per cent were advised against surgery. Eight-two of the 180 patients advised not to have surgery sought a third opinion; the negative second opinion was reversed by the third consultant in 57 of these cases (69.5 per cent). Thus, surgery was rejected by a second or third consultant for only 7.7 per cent of the participating patients. We conclude that many negative second opinions are due to honest disagreement about indications for surgery. We also estimate that although the second-opinion program may produce only modest direct savings in Medicaid expenditures, it probably offers important improvements in the quality of health care.

Cost-Benefit Analysis↗
PubMed1985

Nosocomial rubella--consequences of an outbreak and efficacy of a mandatory immunization program.

An outbreak of rubella in a large metropolitan hospital is described. Nineteen cases among employees and three secondary cases in family members occurred. Nosocomial cases occurred among the 3,900 employees of an adult medical-surgical unit where a voluntary program of rubella immunization was in effect. No cases occurred among the 1,400 employees of the women's and pediatric units with mandatory policies, despite interfacility and community exposure. Ten pregnant women were among the 377 contacts of the cases. Five were sero-negative to rubella. Two who developed clinical rubella, one asymptomatic sero-conversion and one other, all elected to terminate their pregnancies. The remaining woman, exposed in her third trimester delivered a normal infant. We conclude a policy requiring new employees to be rubella immune is more effective in preventing nosocomial rubella than a voluntary program and is desirable in view of the potential consequences of an outbreak to pregnant employees.

Adult↗