Most real medical spending growth is accounted for by beneficial but costly new technology. This paper argues that a missing dimension of our concepts of competition among health plans is a focus on their policy toward new technology. In principle, plans could choose to move rapidly or slowly, inclusively or selectively, toward adopting new technologies, broadly defined. These policies would affect the rates of growth of their premiums, and consumers could choose among plans depending on both the technology policy and premium growth. Legal impediments, physician resistance, and membership turnover are all possible obstacles. Further thought should be given to making technology policy an explicit dimension of plan competition. (+info)
Percutaneous coronary intervention: recommendations for good practice and training.
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Cardiologists undertaking percutaneous coronary intervention (PCI) are excited by the combination of patient and physician satisfaction and technological advance occurring on the background of the necessary manual dexterity. Progress and applicability of percutaneous techniques since their inception in 1977 have been remarkable; a sound evidence base coupled with the enthusiasm and ingenuity of the medical device industry has resulted in a sea change in the treatment of coronary heart disease (CHD), which continues to evolve at breakneck speed. This is the third set of guidelines produced by the British Cardiovascular Intervention Society and the British Cardiac Society. Following the last set of guidelines published in 2000, we have seen PCI activity in the UK increase from 33,652 to 62,780 (87% in four years) such that the PCI to coronary artery bypass grafting ratio has increased to 2.5:1. The impact of drug eluting stents has been profound, and the Department of Health is investigating the feasibility of primary PCI for acute myocardial infarction. Nevertheless, the changes in the structure of National Health Service funding are likely to focus our attention on cost effective treatments and will require physician engagement and sensitive handling if we are to continue the rapid and appropriate growth in our chosen field. It is important with this burgeoning development now occurring on a broad front (in both regional centres and district general hospitals) that we maintain our vigilance on audit and outcome measures so that standards are maintained for both operators and institutions alike. This set of guidelines includes new sections on training, informed consent, and a core evidence base, which we hope you will find useful and informative. (+info)
Improving patient access to novel medical technologies in Europe.
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The European Society of Cardiology (ESC) organized a one-day workshop with clinicians, health economic experts, and health technology appraisal experts to discuss the equity of patient access to novel medical technologies in Europe. Two index technologies were considered: implantable cardioverter defibrillators (ICDs) and drug-eluting stents (DES). The use of ICDs range from 35 implants/million population in Portugal to 166 implants/million population in Germany, whereas for implants of DES (as percentage of total stents) it is lowest in Germany at 14% and high in Portugal at 65%. These differences can in part be explained by a lack of structured implementation of guidelines, the direct cost in relation to the overall healthcare budget, and to differences in procedures and models applied by Health Technology Assessment (HTA) agencies in Europe. The workshop participants concluded that physicians need to be involved in a more structured way in HTA and need to become better acquainted with its methods and terminology. Clinical guidelines should be systematically translated, explained, disseminated, updated, and adopted by cardiologists in Europe. Clinically appropriate, consistent and transparent health economic models need to be developed and high-quality international outcome and cost data should be used. A process for funding of a technology should be developed after a positive recommendation from HTA agencies. Both the ESC and the national cardiac societies should build-up health economic expertise and engage more actively in discussions with stakeholders involved in the provision of healthcare. (+info)
A 2-year study of Gram stain competency assessment in 40 clinical laboratories.
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We used a computer-based competency assessment tool for Gram stain interpretation to assess the performance of 278 laboratory staff from 40 laboratories on 40 multiple-choice questions. We report test reliability, mean scores, median, item difficulty, discrimination, and analysis of the highest- and lowest-scoring questions. The questions were reliable (KR-20 coefficient, 0.80). Overall mean score was 88% (range, 63%-98%). When categorized by cell type, the means were host cells, 93%; other cells (eg, yeast), 92%; gram-positive, 90%; and gram-negative, 88%. When categorized by type of interpretation, the means were other (eg, underdecolorization), 92%; identify by structure (eg, bacterial morphologic features), 91%; and identify by name (eg, genus and species), 87%. Of the 6 highest-scoring questions (mean scores, > or = 99%) 5 were identify by structure and 1 was identify by name. Of the 6 lowest-scoring questions (mean scores, < 75%) 5 were gram-negative and 1 was host cells. By type of interpretation, 2 were identify by structure and 4 were identify by name. Computer-based Gram stain competency assessment examinations are reliable. Our analysis helps laboratories identify areas for continuing education in Gram stain interpretation and will direct future revisions of the tests. (+info)
Toronto hospital reduces sharps injuries by 80%, eliminates blood collection injuries. A case study: Toronto East General Hospital pioneers healthcare worker safety.
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Needlestick and other sharps injuries are a key Canadian public health issue, affecting 70,000 people per year and costing some dollar 140 million. A safety program at Toronto East General Hospital--focusing on blood collection and patient injection--achieved an 80% reduction in injuries within one year (from 41 in 2003 to eight in 2004), with blood collection injuries eliminated entirely. (+info)
HIV safety guidelines and laboratory training. NIOSH.
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At the Centers for Disease Control (CDC), educational activities concerning acquired immunodeficiency syndrome (AIDS) are directed to many target audiences; important among these are health care and public safety workers. Several CDC programs are designed to address the specific education and training needs of these groups. The National Institute for Occupational Safety and Health (NIOSH) has developed a set of occupational safety guidelines directed to fire service personnel, emergency medical technicians, paramedics, and law enforcement and correctional facility personnel. These guidelines provide information on modes of transmission of human immunodeficiency virus (HIV) in the workplace, the risk of transmission, the control of risk, and specific risk-control recommendations. NIOSH also has developed a model curriculum, based on the principles and practices discussed in the guidelines, for use in training workers. The Hospital Infections Program (HIP) at CDC's National Center for Infectious Diseases is responsible for assessing the risk of HIV infection for both health care workers and patients. As part of this effort, HIP has developed guidelines to prevent transmission of HIV and other bloodborne pathogens in health care settings, as well as statements regarding management of occupational exposure to HIV. The Public Health Practice Program Office provides laboratory training to health care workers who are performing HIV- and AIDS-related testing. This training is delivered through the National Laboratory Training Network and through courses given at CDC headquarters in Atlanta. The delivery of laboratory training is supported by the development of training materials and by performance evaluation programs. (+info)
Rules for medical markets: the impact of medicare contractors on coverage policies.
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OBJECTIVE: Examine Medicare's local contractors' claim payment rules, focusing on how technology affects the balancing of competing demands to respond to local medical markets (rule heterogeneity) with concerns about national consistency in payment rules (rule homogeneity). DATA SOURCES: Local medical review policies (LMRPs) posted in policy sets by contractor organizations on the Centers for Medicare and Medicaid Services (CMS) website and a survey of Contractor Medical Directors. STUDY DESIGN: We classified LMRPs based on type (NT=new technology; TE=technology extensions, and UM=utilization management), and examined the effect of technology type on LMRP focus, evidence use, policy revisions, implementation speed, and reference material citation characteristics of LMRPs using multivariate analysis. PRINCIPAL FINDINGS: NT policies were more homogenous, as were policies among contractors related through multistate affiliation or through informal networks. UM policies were more heterogeneous. NT policies were more likely than UM policies to cite research journals as evidence while UM policies were more likely to cite medical reference materials. CONCLUSIONS: Coverage policies associated with new technologies diffuse rapidly and are homogenous compared to utilization management coverage policies. This suggests that new technology policies are responsive to the development of new technologies at the national level. In contrast, utilization management policies are responsive to local heterogeneity in health care practice. Congress has mandated reforms to the contracting process to achieve consistency and reduce duplication. Our data elucidate the nature and sources of variation and will help policymakers strike a balance between homogeneity and local adaptation. (+info)
Racial differences in attitudes toward innovative medical technology.
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BACKGROUND: New medical technologies are used at different rates among whites and blacks. This variation may be partially explained by racial differences in patient innovativeness-the propensity of patients to adopt unfamiliar therapies. OBJECTIVE: To measure how innovativeness varies among patients and how it may influence patients' attitudes toward new medical technologies. DESIGN: Cross-sectional survey. PARTICIPANTS: Primary care patients (n=171-108 blacks, 63 whites) at an urban Veterans Affairs medical center. MEASUREMENTS: Respondents answered questions about their general innovativeness and innovativeness regarding medical technology, and they responded to a vignette describing either a hypothetical new prescription drug or implantable device. RESULTS: There were no significant racial differences in general innovativeness, but whites had higher medical technology innovativeness (P=.001). Whites were also more likely to accept the new prescription drug (P=.003), but did not differ from blacks in acceptance of the new implantable device. In multivariate analyses, lower medical technology innovativeness scores among blacks were significantly associated with less favorable reactions to both the prescription drug (P<.001) and the medical device (P<.001). In contrast, although whites with lower medical technology innovativeness were similarly less inclined to accept the new implantable device (P=.02), there was no significant association between medical technology innovativeness and positive attitudes to the new prescription drug among whites. CONCLUSIONS: Blacks and whites have differing attitudes toward medical innovation. These differences are associated with significant racial differences in response to particular health care technologies. These findings suggest potentially remediable causes for racial differences in the utilization of innovative medical technologies. (+info)