Support of quality and business goals by an ambulatory automated medical record system in Kaiser Permanente of Ohio.
(17/500)
Kaiser Permanente of Ohio has developed a Medical Automated Record System (MARS) to address the business and clinical needs of the organization. The system is currently used by 220 physicians and 110 allied health personnel. To support the quality initiatives of the organization, the system has been programmed to generate reminders, at the moment of care, on compliance with clinical guidelines. This article details examples of compliance improvements with guidelines for the use of aspirin in coronary artery disease, use of influenza vaccinations in members older than 64 years of age, and stratification of asthmatic patients into severity levels; it also summarizes other quality improvements. MARS provides a data stream for electronic billing, which saves the organization the cost of manual billing. In addition, this system reduces operating costs, in particular the number of staff needed to deliver charts and the cost of printing forms. Cost-benefit analysis demonstrates that the system can produce savings in excess of maintenance costs. (+info)
The adoption of provider-based rural health clinics by rural hospitals: a study of market and institutional forces.
(18/500)
OBJECTIVE: To examine the response of rural hospitals to various market and organizational signals by determining the factors that influence whether or not they establish a provider-based rural health clinic (RHC) (a joint Medicare/Medicaid program). DATA SOURCES/STUDY SETTING: Several secondary sources for 1989-1995: the AHA Annual Survey, the PPS Minimum Data Set and a list of RHCs from HCFA, the Area Resource File, and professional associations. The analysis includes all general medical/surgical rural hospitals operating in the United States during the study period. STUDY DESIGN: A longitudinal design and pooled cross-sectional data were used, with the rural hospital as the unit of analysis. Key variables were examined as sets and include measures of competitive pressures (e.g., hospital market share), physician resources, nurse practitioner/physician assistant (NP/PA) practice regulation, hospital performance pressures (e.g., operating margin), innovativeness, and institutional pressure (i.e., the cumulative force of adoption). PRINCIPAL FINDINGS: Adoption of provider-based RHCs by rural hospitals appears to be motivated less as an adaptive response to observable economic or internal organizational signals than as a reaction to bandwagon pressures. CONCLUSIONS: Rural hospitals with limited resources may resort to imitating others because of uncertainty or a limited ability to fully evaluate strategic activities. This can result in actions or behaviors that are not consistent with policy objectives and the perceived need for policy changes. Such activity in turn could have a negative effect on some providers and some rural residents. (+info)
Financial and organizational determinants of hospital diversification into subacute care.
(19/500)
OBJECTIVE: To examine the financial, market, and organizational determinants of hospital diversification into subacute inpatient care by acute care hospitals in order to guide hospital managers in undertaking such diversification efforts. STUDY SETTING: All nongovernment, general, acute care, community hospitals that were operating during the years 1985 through 1991 (3,986 hospitals in total). DATA SOURCES: Cross-sectional, time-series data were drawn from the American Hospital Association's (AHA) Annual Survey of Hospitals, the Health Care Financing Administration's (HCFA) Medicare Cost Reports, a latitude and longitude listing for all community hospital addresses, and the Area Resource File (ARF) published in 1992, which provides county level environmental variables. STUDY DESIGN: The study is longitudinal, enabling the specification of temporal patterns in conversion, causal inferences, and the treatment of right-censoring problems. The unit of analysis is the individual hospital. KEY FINDINGS: Significant differences were found in the average level of subacute care offered by investor-owned versus tax-exempt hospitals. After controlling for selection bias, financial performance, risk, size, occupancy, and other variables, IO hospitals offered 31.3 percent less subacute care than did NFP hospitals. Financial performance and risk are predictors of IO hospitals' diversification into subacute care, but not of NFP hospitals' activities in this market. Resource availability appears to expedite expansion into subacute care for both types of hospitals. CONCLUSIONS: Investment criteria and strategy differ between investor-owned and tax-exempt hospitals. (+info)
Evaluating the sale of a nonprofit health system to a for-profit hospital management company: the Legacy Experience.
(20/500)
OBJECTIVE: To introduce and develop a decision model that can be used by the leadership of nonprofit healthcare organizations to assist them in evaluating whether selling to a for-profit organization is in their community's best interest. STUDY SETTING/DATA SOURCES: A case study of the planning process and decision model that Legacy Health System used to evaluate whether to sell to a for-profit hospital management company and use the proceeds of the sale to establish a community health foundation. Data sources included financial statements of benchmark organizations, internal company records, and numerous existing studies. STUDY DESIGN: The development of the multivariate model was based on insight gathered through a review of the current literature regarding the conversion of nonprofit healthcare organizations. DATA COLLECTION/EXTRACTION METHODS: The effect that conversion from nonprofit to for-profit status would have on each variable was estimated based on assumptions drawn from the current literature and on an analysis of Legacy and for-profit hospital company data. PRINCIPAL FINDINGS: The results of the decision model calculations indicate that the sale of Legacy to a for-profit firm and the subsequent creation of a community foundation would have a negative effect on the local community. CONCLUSIONS: The use of the decision model enabled senior management and trustees to systematically address the conversion question and to conclude that continuing to operate as a nonprofit organization would provide the most benefit to the local community. The model will prove useful to organizations that decide to sell to a for-profit organization as well as those that choose to continue nonprofit operations. For those that decide to sell, the model will assist in minimizing any potential negative effect that conversion may have on the community. The model will help those who choose not to sell to develop a better understanding of the organization's value to the community. (+info)
Should we be doing more to prevent Group C meningococcal infection in school age children? How can we decide?
(21/500)
Meningococcal Group C infections are potentially preventable by vaccination in most cases. Population immunization has not been adopted because the disease is rare and the vaccine effective for only about three years. However, the recent rise in cases in school age children has prompted an assessment of the cost-effectiveness of alternative strategies for management of a case of Group C infection. Chemoprophylaxis and vaccination of close contacts is the most cost-effective strategy but will prevent relatively few cases. Population vaccination prevents considerably more cases, but at a much higher total and marginal cost. An intermediate strategy of giving antibiotics to and vaccinating the school population following a single case, in addition to contact tracing, has intermediate cost-effectiveness. Policy decisions will take into account other important factors but the approach we have taken makes explicit key assumptions so that wider debate including profession and public can be developed. (+info)
Introducing a quality improvement programme to primary healthcare teams.
(22/500)
OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes. (+info)
Technology assessment and the drug use process.
(23/500)
This activity is designed for pharmacists, physicians, physician assistants, nurses, and other healthcare team members, payers for health services, and healthcare executives. OBJECTIVES: Upon completion of this activity, the participant should be able to: 1. Describe the rationale behind, the development of, and the advantages arising from the formulary process, and discuss the health professionals involved in the creation of formularies. 2. Describe the impact of new drug development and technology on the drug use process. 3. Discuss the functions of the pharmacy and therapeutics committee. 4. Describe the impact of consumers on the drug use process. (+info)
Dissecting cost-effectiveness analysis for preventive interventions: a guide for decision makers.
(24/500)
BACKGROUND: Decision makers usually limit their use of economic evaluations of preventive interventions to the cost-effectiveness ratio. OBJECTIVE: To show decision makers how economic evaluations can be used to understand the cost-effectiveness of different options for altering health intervention strategies. OBSERVATIONS: Cost-effectiveness analysis provides insights into many factors that contribute to the overall benefits, hazards, and costs of interventions. This article reviews how epidemiologic and intervention characteristics, costs, natural history, targeting, and current interventions influence the value of prevention strategies. CONCLUSION: Understanding the factors that contribute to the overall costs and effectiveness of interventions should allow decision makers to better adapt interventions to their needs. (+info)