Influence of an interventional program on resource use and cost in pediatric asthma.
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OBJECTIVE: Asthma is the most common chronic condition of childhood, for which morbidity, mortality, and cost are increasing. This study was performed to determine whether patient education and assignment to a primary care provider improve outcomes and cost in the management of pediatric asthma. STUDY DESIGN: A prospective pilot study of 61 patients was conducted with a retrospective review. Data were obtained from health and pharmacy records. PATIENTS AND METHODS: Sixty-one unassigned pediatric asthma patients who were noted to be frequent users of emergency department services and who had no primary care provider were identified. This cohort received asthma education and was assigned a provider trained in the national asthma guidelines. Hospital admissions, Emergency Department and clinic visits, use of beta 2 agonists and anti-inflammatory drugs, number of chest radiographs, and continuity of care were recorded for a mean of 58.1 months before and 11.2 months after the intervention. A cost analysis was done. RESULTS: All measured parameters showed favorable changes after intervention, with the decrease in the number of prescriptions of monthly inhaled anti-inflammatory drugs and chest radiographs ordered being statistically significant (P = 0.007 and P = 0.040, respectively). Monthly admissions, Emergency Department visits, and clinic visits declined after intervention when evaluated after 22.8 months of follow up. Annual resource savings after intervention was estimated to be $4845.29 per patient for this military hospital. CONCLUSIONS: A combined intervention consisting of provider and patient education and assignment to a primary care provider was associated with improved care and economic outcomes in this group. (+info)
Technology assessment and requirements analysis: a process to facilitate decision making in picture archiving and communications system implementation.
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In a time of decreasing resources, managers need a tool to manage their resources effectively, support clinical requirements, and replace aging equipment in order to ensure adequate clinical care. To do this successfully, one must be able to perform technology assessment and capital equipment asset management. The lack of a commercial system that adequately performed technology needs assessment and addressed the unique needs of the military led to the development of an in-house Technology Assessment and Requirements Analysis (TARA) program. The TARA is a tool that provides an unbiased review of clinical operations and the resulting capital equipment requirements for military hospitals. The TARA report allows for the development of acquisition strategies for new equipment, enhances personnel management, and improves and streamlines clinical operations and processes. (+info)
Parlaying digital imaging and communications in medicine and open architecture to our advantage: the new Department of Defense picture archiving and communications system.
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The Department of Defense (DoD) undertook a major systems specification, acquisition, and implementation project of multivendor picture archiving and communications system (PACS) and teleradiology systems during 1997 with deployment of the first systems in 1998. These systems differ from their DoD predecessor system in being multivendor in origin, specifying adherence to the developing Digital Imaging and Communications in Medicine (DICOM) 3.0 standard and all of its service classes, emphasizing open architecture, using personal computer (PC) and web-based image viewing access, having radiologic telepresence over large geographic areas as a primary focus of implementation, and requiring bidirectional interfacing with the DoD hospital information system (HIS). The benefits and advantages to the military health-care system accrue through the enabling of a seamless implementation of a virtual radiology operational environment throughout this vast healthcare organization providing efficient general and subspecialty radiologic interpretive and consultative services for our medical beneficiaries to any healthcare provider, anywhere and at any time of the night or day. (+info)
Clinical services assessment and reengineering: lessons learned.
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Healthcare enterprises often "acquire and install" picture archiving and communications systems (PACS) without examining many of the care delivery processes and information flows that will be affected. Many times these unexamined factors can delay or be the cause of failure of the PACS project. This article presents issues that were worked through as part of a PACS clinical services assessment and reengineering analysis for several US military medical treatment facilities. (+info)
Benchmark testing the Digital Imaging Network-Picture Archiving and Communications System proposal of the Department of Defense.
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The Department of Defense issued a Request for Proposal (RFP) for its next generation Picture Archiving and Communications System in January of 1997. The RFP was titled Digital Imaging Network-Picture Archiving and Communications System (DIN-PACS). Benchmark testing of the proposed vendors' systems occurred during the summer of 1997. This article highlights the methods for test material and test system organization, the major areas tested, and conduct of actual testing. Department of Defense and contract personnel wrote test procedures for benchmark testing based on the important features of the DIN-PACS Request for Proposal. Identical testing was performed with each vendor's system. The Digital Imaging and Communications in Medicine (DICOM) standard images used for the Benchmark Testing included all modalities. The images were verified as being DICOM standard compliant by the Mallinckrodt Institute of Radiology, Electronic Radiology Laboratory. The Johns Hopkins University Applied Physics Laboratory prepared the Unix-based server for the DICOM images and operated it during testing. The server was loaded with the images and shipped to each vendor's facility for on-site testing. The Defense Supply Center, Philadelphia (DSCP), the Department of Defense agency managing the DIN-PACS contract, provided representatives at each vendor site to ensure all tests were performed equitably and without bias. Each vendor's system was evaluated in the following nine major areas: DICOM Compliance; System Storage and Archive of Images; Network Performance; Workstation Performance; Radiology Information System Performance; Composite Health Care System/Health Level 7 communications standard Interface Performance; Teleradiology Performance; Quality Control; and Failover Functionality. These major sections were subdivided into workable test procedures and were then scored. A combined score for each section was compiled from this data. The names of the involved vendors and the scoring for each is contract sensitive and therefore can not be discussed. All of the vendors that underwent the benchmark testing did well. There was no one vendor that was markedly superior or inferior. There was a typical bell shaped curve of abilities. Each vendor had their own strong points and weaknesses. A standardized benchmark protocol and testing system for PACS architectures would be of great value to all agencies planning to purchase a PACS. This added information would assure the purchased system meets the needed functional requirements as outlined by the purchasers PACS Request for Proposal. (+info)
Do aftercare services reduce inpatient psychiatric readmissions?
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OBJECTIVE: To determine whether aftercare services reduce the likelihood that children and adolescents will be readmitted to inpatient psychiatric facilities. DATA SOURCES/STUDY SETTING: Analyses of data from the Fort Bragg Demonstration. Data were based on 204 sample individuals (children and adolescents), all of whom were discharged from inpatient facilities during the study period. STUDY DESIGN: These analyses use hazard modeling to examine the impact of aftercare services on the likelihood of readmission. Comparisons of individuals for whom the timing of aftercare services differ are adjusted for a wide range of individual characteristics, including client demographics, diagnosis, symptomatology, and psychosocial functioning. DATA COLLECTION/EXTRACTION METHODS: Detailed data on psychopathology, symptomatology, and psychosocial functioning were collected on individuals included in these analyses. This information was taken from structured diagnostic interviews and behavior checklists, including the Child Behavior Checklist and Diagnostic Interview Schedule for Children, completed by the child and his or her caretaker. Information on the use of mental health services was taken from insurance claims and a management information system, and was used to identify the period from discharge to readmission and to describe the client's use of outpatient therapy, case management, intermediate (or stepdown) services, and residential treatment centers during this period. PRINCIPAL FINDINGS/CONCLUSIONS: Using Cox models that allow for censoring and that include the use of aftercare services as time-varying covariates, we find that aftercare services generally do not influence the likelihood of inpatient readmission. For the lower middle class families included in this study, the estimated effect of aftercare is not statistically significant and has limited practical significance. When we look at specific forms of aftercare, we find that outpatient therapy has the largest effect and that stepdown services in intermediate settings have the smallest. We also identify family and individual characteristics that influence the likelihood of readmission. (+info)
Picture archiving and communication systems planning: a methodology.
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This article presents the Picture Archiving and Communication Systems (PACS) planning methodology used by the Department of Defense's (DOD) Joint Imaging Technology Project Office (JITPO). This methodology evaluates four areas of PACS planning and implementation: strategic planning, clinical scenario planning, installation planning, and implementation planning. The first task is to develop a PACS team, from the local facility, that will execute the program. A written PACS plan is developed by the JITPO, with active input and final say from the site's PACS team. This plan includes the PACS goals and objectives, clinical requirements, facility requirements, and the status of the implementation. This methodology, when applied fully at a military clinical site, has resulted in the site obtaining best "value" in terms of cost and performance by requiring the DOD's contracted PACS vendors to propose a PACS package that meets or exceeds the site's unique requirements. The identification of the requirements and the matching of a known PACS configuration with them has reduced the number of unknowns within the vendors' proposals and created true competition in both initial cost and the cost to maintain PACS in the maintenance years. Although there are certain factors unique to planning a military PACS, such as preselected vendors, the planning methodology described in this article should provide a valuable strategy for any hospital planning a PACS. (+info)
The Seamen's Hospital Society: a progenitor of the tropical institutions.
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1999 marks the centenary of the two major British Schools of Tropical Medicine, founded in London and Liverpool, respectively. The origin(s) of the former clearly lies in the Seamen's Hospital Society, which dates from 1821. It seems likely that the foundation of this school (with Government support) also acted as a catalyst for the school at Liverpool, which in fact opened its doors a few months before that in London. (+info)