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Cooper, Ryan. "Task Assignment and Cost Control in Primary Medical Care." Academy of Management Proceedings 2018, no. 1 (August 2018): 14955. http://dx.doi.org/10.5465/ambpp.2018.203.
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Macklin, Ruth. "Cost Containment in Infection Control: Ethical Problems in Rationing Medical Care." Infection Control 6, no. 9 (September 1985): 375–80. http://dx.doi.org/10.1017/s0195941700063359.
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The era of cost containment is upon us. Bureaucrats and regulators, politicians and insurance administrators have begun to devise schemes for reducing the costs of hospital care and medical services in a country justly proud of the quality of its health care. The term “cost containment” has a neutral ring to it, a tone deliberately chosen by policy makers to soften the impact of its effects. The concept has an aura of virtue, conjuring an image of overflowing expenditures that must be put back into the container. But let us recognize the harsh reality that cost containment is simply another term for rationing, a notion that has somewhat unsavory connotations.The need to embark on rationing arises when a crisis of available goods or services is imminent. We are told that too much money is being spent today on health care in the US. Since spending too much on anything is considered wasteful, and since wastefulness is at least an inefficient, if not an unethical way to treat resources, the conclusion seems inescapable that there is a moral imperative to cut costs in the health care sector. To be sure, the goals of eliminating waste and reducing excessive costs should be pursued by hospitals and physicians alike. But let us not hide behind these noble goals and accept uncritically the idea that to increase efficiency in delivering health care, it is necessary to embark on rationing schemes.
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Mohr, John, Michelle Peninger, and Luis Ostrosky-Zeichner. "Infection Control in Intensive Care Units." Journal of Pharmacy Practice 18, no. 2 (April 2005): 84–90. http://dx.doi.org/10.1177/0897190004273569.
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For patients in intensive care units, the development of an infection is associated with an increase in morbidity, mortality, and cost. These infections are largely preventable through the implementation of infection control programs. Infection control programs must focus on 3 general strategies: (1) prevention of health care-associated infections, (2) containment of pathogens that pose a health risk and/or are resistant to routine antibiotics, and (3) development of strategies to limit the emergence of resistant microorganisms through optimal and appropriate antimicrobial utilization. The purpose of this article is to review these 3 general strategies.
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Isenberg, Henry D. "Cost Containment in Infection Control: Is Cost Effective Ordering of Microbiology Tests for Infection Control Possible?" Infection Control 6, no. 10 (October 1985): 425–27. http://dx.doi.org/10.1017/s0195941700063530.
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Prospective payment fever is an all pervasive affliction that will spare no segment of the health care field. The implied rigidity of these regulations will probably not accommodate arguments that infection control efforts are cost-effective in the long run. It shall force all who labor in this field to exercise judicious restraint in the use of institutional resources. Microbiological analyses provide the most factual information lor infection control efforts. However, recent graduates of medical and nursing schools are the victims of the de-emphasis of bread-and-butter microbiology in their curricula. They lack the ability to request only clinically relevant examinations and do not appreciate the implications of microbiological results with respect to the patient and the health of the hospital or the community at large.Cost-effective ordering of microbiological and related patient examinations must, therefore, be based on an educational effort that indoctrinates responsible personnel in the appropriateness of requests based on clinical judgment and laboratory instructions. The DRG-induced change in the basic philosophy of patient care demands that microbiologists must become involved in the clinical use of the information they generate, ie, in the relevance of laboratory data to the care of patients. This interaction must benefit the laboratory scientist, for he or she can now insist that important patient information accompany each specimen.
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Reissman, Debi L. "Cost Containment Strategies in Managed Care Pharmacy Programs." Journal of Pharmacy Practice 5, no. 2 (April 1992): 72–74. http://dx.doi.org/10.1177/089719009200500205.
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Over the past several years prescription drug costs have been escalating at a rate higher than any other single medical expense. For this reason, managed care entities have been focusing much more attention on their prescription drug programs and searching for the magical answer of how to reduce or at least control the spiraling costs. The following article illustrates one author's views and experiences in the management of prescription drug programs. Although the topics discussed in this article are not meant to be all inclusive, several major cost containment strategies, including benefit design, pharmacy network, reimbursement levels, member copayments, formulary systems, physician incentives and others, are highlighted.
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Oesterman, Paul J. "Health Maintenance Organization Drug Education Pharmacists' Influence on Acid Gastric Drug Prescribing and Costs." Journal of Pharmacy Practice 7, no. 4 (August 1994): 155–64. http://dx.doi.org/10.1177/089719009400700404.
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With health care reform came the advent of cost-conscious prescribing. Many measures contributed to this, including formulary control, physician education, and clinical pharmacy. Initial efforts in this regard were limited to the in-patient setting, but as health care reform continued, the significance of cost-effective prescribing in the ambulatory care setting has evolved. This article provides a brief historical look at cost-effective prescribing and how the efforts of a clinical pharmacist have successfully influenced the prescribing patterns for the acid-gastric products, and reduced expenditures in a Northern California health maintenance organization (HMO) medical center.
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Simpson, Kit N., Bryant A. Seamon, Brittany N. Hand, Courtney O. Roldan, David J. Taber, William P. Moran, and Annie N. Simpson. "Effect of frailty on resource use and cost for Medicare patients." Journal of Comparative Effectiveness Research 7, no. 8 (August 2018): 817–25. http://dx.doi.org/10.2217/cer-2018-0029.
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Aim: The effects of frailty and multiple chronic conditions (MCCs) on cost of care are rarely disentangled in archival data studies. We identify the marginal contribution of frailty to medical care cost estimates using Medicare data. Materials & methods: Use of the Faurot frailty score to identify differences in acute medical events and cost of care for patients, controlling for MCCs and medication use. Results: Estimated marginal cost of frailty was US$10,690 after controlling for demographics, comorbid conditions, polypharmacy and use of potentially inappropriate medications. Conclusion: Frailty contributes greatly to cost of care, but while often correlated, is not synonymous with MCCs. Thus, it is important to control separately for frailty in studies that compare medical care use and cost.
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O'Keeffe-Rosetti, M. C., M. C. Hornbrook, P. A. Fishman, D. P. Ritzwoller, E. M. Keast, J. Staab, J. E. Lafata, and R. Salloum. "A Standardized Relative Resource Cost Model for Medical Care: Application to Cancer Control Programs." JNCI Monographs 2013, no. 46 (August 1, 2013): 106–16. http://dx.doi.org/10.1093/jncimonographs/lgt002.
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Simonet, Daniel. "Medical Practice under Managed Care: Cost-control Mechanisms and Impact on Quality of Service." Public Organization Review 5, no. 2 (June 2005): 157–76. http://dx.doi.org/10.1007/s11115-005-0954-8.
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Hall, Mark A., and Carl E. Schneider. "Can Consumers Control Health-Care Costs?" Forum for Health Economics and Policy 15, no. 3 (September 10, 2012): 23–52. http://dx.doi.org/10.1515/fhep-2012-0008.
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Abstract The ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today’s health policy watchword. This article evaluates consumerism and the regulatory mechanism of which it is essentially an example – legally mandated disclosure of information. We do so by assessing the crucial assumptions about human nature on which consumerism and mandated disclosure depend. Consumerism operates in a variety of contexts in a variety of ways with a variety of aims. To assess so protean a thing, we ask what a patient’s life would really be like in a consumerist world. The literature abounds in theories about how medical consumers should behave. We look for empirical evidence about how real people actually buy health plans, choose providers, and select treatments. We conclude that consumerism is unlikely to accomplish its goals. Consumerism’s prerequisites are too many and too demanding. First, consumers must have choices that include the coverage, care-takers, and care they want. Second, reliable information about those choices must be available. Third, information must be put before consumers in helpful ways, especially by doctors. Fourth, the information must be complete and comprehensible enough for consumers to use it. Fifth, consumers must understand what they are told. Sixth, consumers must actually analyze the information and do so well enough to make good choices. Our review of the empirical evidence concludes that these prerequisites cannot be met reliably most of the time. At every stage people encounter daunting hurdles. Like so many other dreams of controlling costs and giving patients control, consumerism is doomed to disappoint. This does not mean that consumerist tools should never be used. If all that consumerism accomplished is to raise general cost-consciousness among patients, still, it could make a substantial contribution to the larger cost-control efforts by insurers and the government. Once patients bear responsibility for much day-to-day spending on their health needs, they should be increasingly sensitized to the difficult trade-offs that abound in medical care and might even begin to understand that public and private health insurers have a legitimate interest in controlling medical spending.
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Yıldız, M. Said, and M. Mahmud Khan. "Hospital Level Inventory Control and System-Wide Cost Savings: A Case Study from Turkey." Journal of Health Management 20, no. 4 (October 29, 2018): 498–507. http://dx.doi.org/10.1177/0972063418799183.
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Health Transformation Program (HTP) of Turkey, initiated in 2003, improved access to care and quality of health care services. In 2009, HTP implemented a centralized web-based information system to manage inventories of public hospitals. Prior to the introduction of inventory management, significant medical resources were wasted because of misuse, non-use and expiration of medical supplies. The objective of inventory management was to improve the efficiency of hospitals by projecting quantities of items likely to be needed by hospitals over a three-month period. The system also allowed transfer of unneeded and surplus items from one hospital to another. This article estimated cost savings for the health care system through the inter-hospital transfer of items. The success of inventory management was evaluated by using indicators such as the value of medical commodities purchased per unit of service delivered, value of stock to purchase ratios and the value of inter-hospital transfers. Trends in purchase, storage and transfer indicate that the new web-based inventory management infrastructure helped the hospital sector to become more efficient in terms of size of stocks held and inter-temporal changes in the value of stocks. It reduced system-wide waste of medical goods and pharmaceuticals, improved effective use of commodities and reduced storage cost.
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Aldila, Dipo, Herningtyas Padma, Khusnul Khotimah, Bevina Desjwiandra, and Hengki Tasman. "Analyzing the MERS disease control strategy through an optimal control problem." International Journal of Applied Mathematics and Computer Science 28, no. 1 (March 1, 2018): 169–84. http://dx.doi.org/10.2478/amcs-2018-0013.
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AbstractA deterministic mathematical model of the Middle East respiratory syndrome (MERS) disease is introduced. Medical masks, supportive care treatment and a government campaign about the importance of medical masks will be involved in the model as time dependent variables. The problem is formulated as an optimal control one to minimize the number of infected people and keep the intervention costs as low as possible. Assuming that all control variables are constant, we find a disease free equilibrium point and an endemic equilibrium point explicitly. The existence and local stability criteria of these equilibria depend on the basic reproduction number. A sensitivity analysis of the basic reproduction number with respect to control parameters tells us that the intervention on medical mask use and the campaign about the importance of medical masks are much more effective for reducing the basic reproduction number than supportive care intervention. Numerical experiments for optimal control problems are presented for three different scenarios, i.e., a scenario of different initial conditions for the human population, a scenario of different initial basic reproduction numbers and a scenario of different budget limitations. Under budget limitations, it is much better to implement the medical mask intervention in the field, rather than give supportive care to control the spread of the MERS disease in the endemic prevention scenario. On the other hand, the medical mask intervention should be implemented partially together with supportive care to obtain the lowest number of infected people, with the lowest cost in the endemic reduction scenario.
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Park, Minjung, Jimin Park, and Soonman Kwon. "Effect of a Comprehensive Health Care Program by Korean Medicine Doctors on Medical Care Utilization for Common Infectious Diseases in Child-Care Centers." Evidence-Based Complementary and Alternative Medicine 2014 (2014): 1–10. http://dx.doi.org/10.1155/2014/781675.
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As the role of traditional medicine in community health improvement increases, a comprehensive health care program for infectious diseases management in child-care centers by Korean medicine doctors was developed. The purpose of this study is to evaluate the effects of the program intervention on infection-related medical care utilization among children. The study used a quasi-experimental design with nonequivalent control group, comparing pre- and post-intervention data of the same children. The program implemented interventions in terms of management, education, and medical examination for the teachers, parents, and children in 12-week period. The frequency of utilization, cost, and prescription days of drugs and antibiotics due to infectious diseases prior to the intervention were compared with those during the 3-month intervention, using health insurance claim data. A panel analysis was also conducted to support the findings. A significant reduction (12%) in infection-related visit days of hospitals was observed with the intervention (incident rate ratio = 0.88,P=0.01). And medical cost, drug prescription days, and antibiotics prescription days were decreased, although not statistically significant. A further cost-effectiveness analysis in terms of social perspectives, considering the opportunity costs for guardians to take children to medical institutions, would be needed.
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Souêtre, E., R. M. A. Thwaites, and H. L. Yeardley. "Economic impact of Alzheimer's disease in the United Kingdom." British Journal of Psychiatry 174, no. 1 (January 1999): 51–55. http://dx.doi.org/10.1192/bjp.174.1.51.
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BackgroundWhile the costs associated with Alzheimer's disease have been shown to be significant, there are few data relating cost of care to severity of the disease.AimsWe aimed to compare the costs associated with different severities of Alzheimer's disease with those incurred by control subjects over a three-month period.MethodIn this cross-sectional, multicentre, naturalistic analysis, non-institutionalised patients with Alzheimer's disease (128), their care-givers (128), and 56 matched controls were interviewed once to establish resource use over the previous three months. Patients were stratified into three severity groups according to their Mini Mental State Examination score. Costs were calculated from the perspective of society as a whole.ResultsOver the three-month period, total mean cost per control subject (£387) was minor compared with mean cost incurred by patients with mild (£6616), moderate (£10 250) and severe (£13 593) Alzheimer's disease. Indirect cost, mainly time spent by care-givers, was the main cost component in all groups (68.6%), followed by direct medical costs (24.7%)ConclusionsThe cost of care for an Alzheimer's disease patient is directly related to the severity of the patient's illness.
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Bryant, Kelsey B., Andrew E. Moran, Dhruv S. Kazi, Yiyi Zhang, Joanne Penko, Natalia Ruiz-Negrón, Pamela Coxson, et al. "Cost-Effectiveness of Hypertension Treatment by Pharmacists in Black Barbershops." Circulation 143, no. 24 (June 15, 2021): 2384–94. http://dx.doi.org/10.1161/circulationaha.120.051683.
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Background: In LABBPS (Los Angeles Barbershop Blood Pressure Study), pharmacist-led hypertension care in Los Angeles County Black-owned barbershops significantly improved blood pressure control in non-Hispanic Black men with uncontrolled hypertension at baseline. In this analysis, 10-year health outcomes and health care costs of 1 year of the LABBPS intervention versus control are projected. Methods: A discrete event simulation of hypertension care processes projected blood pressure, medication-related adverse events, fatal and nonfatal cardiovascular disease events, and noncardiovascular disease death in LABBPS participants. Program costs, total direct health care costs (2019 US dollars), and quality-adjusted life-years (QALYs) were estimated for the LABBPS intervention and control arms from a health care sector perspective over a 10-year horizon. Future costs and QALYs were discounted 3% annually. High and intermediate cost-effectiveness thresholds were defined as <$50 000 and <$150 000 per QALY gained, respectively. Results: At 10 years, the intervention was projected to cost an average of $2356 (95% uncertainty interval, –$264 to $4611) more per participant than the control arm and gain 0.06 (95% uncertainty interval, 0.01–0.10) QALYs. The LABBPS intervention was highly cost-effective, with a mean cost of $42 717 per QALY gained (58% probability of being highly and 96% of being at least intermediately cost-effective). Exclusive use of generic drugs improved the cost-effectiveness to $17 162 per QALY gained. The LABBPS intervention would be only intermediately cost-effective if pharmacists were less likely to intensify antihypertensive medications when systolic blood pressure was ≥150 mm Hg or if pharmacist weekly time driving to barbershops increased. Conclusions: Hypertension care delivered by clinical pharmacists in Black barbershops is a highly cost-effective way to improve blood pressure control in Black men.
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Krajden, Mel, Margot Kuo, Brandon Zagorski, Maria Alvarez, Amanda Yu, and Murray Krahn. "Health Care Costs Associated with Hepatitis C: A Longitudinal Cohort Study." Canadian Journal of Gastroenterology 24, no. 12 (2010): 717–26. http://dx.doi.org/10.1155/2010/569692.
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BACKGROUND: Disease-specific estimates of medical costs are important for health policy decision making.OBJECTIVE: To identify predictors of health care costs associated with hepatitis C virus (HCV) seropositivity across disease phases.METHODS: HCV laboratory tests from the BC Centre for Disease Control were linked to administrative data pertaining to health services and drugs dispensed to estimate costs among case subjects and controls. The case group comprised HCV seropositive individuals (n=20,001), and the control group comprised single-tested, HCV seronegative persons (n=70,752) identified between January 1997 and December 2004. Subject observation time was assigned to the three following disease phases: initial phase (after diagnosis), late phase (late-stage liver disease) and predeath phase (12 months before death). Case subjects and controls were matched for age, sex and a propensity score within each phase to determine the net cost attributable to HCV seropositivity, and were adjusted for demographic and clinical factors.RESULTS: Costs increased with disease progression, with hospitalization being the highest cost component in all phases. Initial and late phase net costs (2005 Canadian dollars) were $1,850 and $6,000 per patient per year, respectively. Costs among case subjects were driven by age, comorbidities, mental illness, illicit drug use and HIV coinfection. While predeath case subject and control costs were virtually the same, costs were high and case subjects died at a younger age.CONCLUSION: HCV seropositivity is associated with increased medical costs driven by viral sequelae and medicosocial vulnerabilities (ie, mental illness, illicit drug use and HIV coinfection). Cost mitigation and health outcome improvements will require broad-based prevention programming to reduce vulnerabilities and HCV treatment to prevent disease progression, respectively.
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Hengeveld, Michiel W., Frans A. J. M. Ancion, and Harry G. M. Rooijmans. "Psychiatric Consultations with Depressed Medical Inpatients: A Randomized Controlled Cost-Effectiveness Study." International Journal of Psychiatry in Medicine 18, no. 1 (March 1989): 33–43. http://dx.doi.org/10.2190/587y-bhup-8nbu-5c0e.
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Nonspecific, supportive psychiatric consultations were performed with a random sample of thirty-three general medical inpatients scoring thirteen or more on the Beck Depression Inventory. The control group consisted of thirty-five patients, matched for sex, marital status, somatic history, and seriousness of illness. The number of patients receiving no analgesic and/or psychotropic medication in the consult group (39%) was significantly greater than that in the control group (17%). When compared with their mean BDI score on admission, the BDI score just before discharge had decreased significantly in the consult group (from 20 to 13), but not in the control group (from 19 to 16). Probably because the patient sample was too heterogeneous, with too low a prevalence of mental disorders (45%), a significant reduction in other medical care expenditures and in length of hospital stay could not be demonstrated.
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Wong, Winston, Joseph Cooper, Daniel Winn, Tim Olson, Ram Swarup Trehan, Jeffrey A. Scott, and Bruce A. Feinberg. "Oncology medical home: Payer return on investment (ROI)." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e17582-e17582. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e17582.
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e17582 Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer clinical pathway in the United States in August 2008. Due to the early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of care. We analyzed payer ROI after year +1 of the medical home program. Methods: The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services allowing physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. Physicians were encouraged to commit to an intensive continuous quality improvement (CQI) program, which included an end-of-life initiative and a post chemotherapy nurse call-back program that would lower costs by decreasing emergency room and hospital admissions. Physicians participating in the first CFBCBS pathway program were eligible to join the medical home program; physicians who chose not to join made up the control group. Data were collected from April 2010 to March 2012. Medical home ROI was calculated by subtracting the total weighted cost per patient for the medical home group from the total risk-adjusted cost per patient for the control group multiplied by the total number of patients in the medical home program. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. The control group was comprised of 39 practices (103 physicians, 2031 patients). Total weighted cost per patient for the medical home program for year +1 was $26,702. Risk-adjusted cost per patient for the control group for year +1 was $30,670. The medical home program provided a gross savings of $2,016,868 compared to the first CFBCBS pathways program. Conclusions: Significant savings can be achieved in a provider group already compliant with a mature pathways program. A CQI program can directly and favorably impact patient outcomes and ROI via presumed reduction in emergency room and hospital admissions.
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Rutten, Frans, and H. Banta David. "Health Care Technolgies in The Netherlands." International Journal of Technology Assessment in Health Care 4, no. 2 (April 1988): 229–38. http://dx.doi.org/10.1017/s0266462300004050.
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AbstractThis article argues that while health care and government authorities in the Netherlands in the last decades have attempted to rationalize the diffusion of medical technology, much work remains to be done. The authors contend that though a mix of direct government regulation and economic incentives will be needed, regulation by incentive is more effective than regulation by directive in achieving cost effective use of technology. Generally, bureaucratic structures provide only limited opportunities for tight control of the diffusion of medical technologies. The article offers possible future strategies for directing the adoption and use of medical technologies and stresses the importance of reliable infor mation culled from comprehensive technology assessments.
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Moncrieff, Abigail R., and Manisha Padi. "Beyond Payment and Delivery Reform: The Individual Mandate's Cost-Control Potential." American Journal of Law & Medicine 40, no. 2-3 (June 2014): 185–94. http://dx.doi.org/10.1177/009885881404000201.
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In a symposium focused on healthcare cost control, most of our authors have unsurprisingly highlighted and assessed Obamacare’s payment and delivery reforms—the supply-side efforts to decrease costs of medical treatment. But there is another party in healthcare decision-making who is equally or even more important: the patient. The question we will tackle here is whether the individual mandate and its accompanying patient-centered insurance reforms might decrease costs for patients in ways that ought to matter in assessing Obamacare’s cost control provisions.The individual mandate’s cost control potential lies in its reduction or even elimination of patients’ decision costs. The mandate, together with its minimum coverage requirements and a handful of the statute’s substantive insurance reforms, combats demand-side inefficiencies that might arise from patients’ bounded rationality. Decisions about whether to buy commercial insurance, how much insurance to buy, whether to consume preventive care, and how much to pay for that care are all difficult decisions. In order to make optimal choices, patients need a lot of information that is costly to obtain and to evaluate.
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Zheleznyakova, I. A., L. A. Kovaleva, and T. A. Khelisupali. "Individual cost accounting in the management of medical organizations." FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology 12, no. 1 (May 23, 2019): 55–59. http://dx.doi.org/10.17749/2070-4909.2019.12.1.55-59.
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In the modern economic conditions, the rational planning of costs and the complex process optimization are essential requirements to all organizations. Knowledge of costs is needed to correctly assess the economic performance of an organization. Competent and timely correction of tariffs for the obligatory medical insurance and rationalization of the requested financing of the medical organization depends on this assessment. In the present study, we analyze various methods of personalized cost accounting: the ratio of costs to charges (RCC); relative value unit (RVU); time-driven activity-based costing (TDABC), and the possibility of their adaptation to the specific needs of medical organizations. The personalized cost accounting incorporated into a medical information system allows for controlling, planning and carrying out a close internal management of financial activity. This function helps decision-makers: control the use of funds for medical care provision; increase the efficiency of management decisions; justify the prices of paid medical services; define the deficit and surplus work units; analyze the treatment cost for each patient, considering the diagnosis, method of treatment, age and other classification signs, including the reference to specialized departments; reduce the unnecessary “paper” work load on the medical personnel; model the future needs of the organization in accordance with the planned changes in the hospitalization policy; optimize, control and plan the budget with regard to the established standards of financial expenses. Implementation of this approach is expected to increase the work efficiency in most medical organizations and the entire healthcare system.
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Yassi, Annalee, Myrna McGill, Donna Holton, and Lindsay Nicolle. "Morbidity, Cost and Role of Health Care Worker Transmission in an Influenza Outbreak in a Tertiary Care Hospital." Canadian Journal of Infectious Diseases 4, no. 1 (1993): 52–56. http://dx.doi.org/10.1155/1993/498236.
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An influenza A outbreak involving 17 health care workers (HCWs) and 16 chronic geriatric patients on a ward in a tertiary care hospital was reviewed. Thirty-seven per cent of all HCWs and 47% of patients on the affected wards became ill with influenza. Three patients died during the outbreak. The majority of health care workers became ill prior to detecting the first patient case of influenza, suggesting that nosocomial spread from HCWs to patients may have occurred. Only 13.7% of the staff and 5.9% of the patients had been vaccinated prior to the outbreak. Lost time due to HCW absenteeism, outbreak-related medication costs and additional staff time involved in outbreak control resulted in considerable cost to the hospital. It is suggested that much of this cost, as well as morbidity and possibly mortality, could have been avoided by increased immunization of HCWs and patients.
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Langabeer, James R., Tiffany Champagne-Langabeer, Diaa Alqusairi, Junghyun Kim, Adria Jackson, David Persse, and Michael Gonzalez. "Cost–benefit analysis of telehealth in pre-hospital care." Journal of Telemedicine and Telecare 23, no. 8 (December 5, 2016): 747–51. http://dx.doi.org/10.1177/1357633x16680541.
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Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost–benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p < .0001). The programme produced a $928,000 annual cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS ‘treat and transport to ED’ model.
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Kullmann, Tamás, and Stéphane Culine. "Treatment of anaemia in medical oncology." Orvosi Hetilap 153, no. 25 (June 2012): 973–77. http://dx.doi.org/10.1556/oh.2012.29371.
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Development of cytotoxic chemotherapy, which has several side effects, has resulted in the development in supportive care as well. Two families of novel drugs have spread in the care of chemotherapy induced anaemia: human recombinant erythropoietin and intravenous iron. They were praised for the decreased transfusion demand and the increased quality of life. However, if we read the literature critically, our enthusiasm should be decreased. New data show an unfavourable impact of erythropoietin on life expectancy. Furthermore, the health care policy has changed since the introduction of erythropoietin 25 years ago. Transfusion control has improved and cost awareness in health care has increased. Recommendations of the American Societies of Haematology and Clinical Oncology reflect on these considerations. Erythropoietin is not recommended in adjuvant settings. The choice between erythropoietin and transfusion is conferred to the clinician in case of the development of metastases. No sufficient scientific argument was found to support the use of intravenous iron supplementation. Orv. Hetil., 2012, 153, 973–977.
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Horn, Susan D., Phoebe D. Sharkey, and Richard Levy. "A Managed Care Pharmacoeconomic Research Model Based on the Managed Care Outcomes Project." Journal of Pharmacy Practice 8, no. 4 (August 1995): 172–77. http://dx.doi.org/10.1177/089719009500800405.
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Many American health care facilities have come to understand that quality controls cost. Clinical practice improvement (CPI) is a methodology that creates a clinical laboratory, built into the everyday practice setting, to find and test the best practices. A CPI study is an analysis of the content and timing of the individual steps of a medical care process to produce better clinical outcomes for the least necessary cost over the continuum of a patient's care. Statistical analyses are used to determine whether and how much a particular step actually improves medical outcomes. Systematic determination of individual medical process steps that improve medical outcomes is the best way to develop demonstrably better care and practice. Combining CPI methodology and a clinical quality monitor creates a dynamic environment in which all patient encounters potentially contribute to improving the process of care. We describe a recent multisite study: the Managed Care Outcomes Project (MCOP). The MCOP study design permits us to compare the effects of various pharmaceutical treatments on resource utilization in actual practice in managed care organizations. The MCOP database is an important resource for developing information required to design systems-based disease management programs. Copyright © 1995 by W.B. Saunders Company
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West, Timothy E., Cile Guerry, Mary Hiott, Nancy Morrow, Katherine Ward, and Cassandra D. Salgado. "Effect of Targeted Surveillance for Control of Methicillin-ResistantStaphylococcus aureusin a Community Hospital System." Infection Control & Hospital Epidemiology 27, no. 3 (March 2006): 233–38. http://dx.doi.org/10.1086/500372.
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Objective.To examine the cost associated with targeted surveillance for methicillin-resistantStaphylococcus aureus(MRSA) and the effect of such surveillance on the rate of nosocomial MRSA infection in a community hospital system.Design.A before-and-after study comparing the rate of MRSA infection before (BES) and after (AES) the initiation of expanded surveillance. Cost-effectiveness was calculated as the difference between the cost savings associated with preventing nosocomial MRSA bacteremias and surgical site infections AES and the cost of MRSA cultures and contact isolation for patients colonized with MRSA.Setting and Participants.Patients in a 400-bed tertiary-care facility (Roper Hospital) and a 180-bed suburban hospital (St. Francis Hospital), both in Charleston, South Carolina.Interventions.Beginning in September 2001, patients were screened for MRSA colonization upon admission to the intensive care unit and weekly thereafter. In July 2002, surveillance was expanded to include targeted screening of patients admitted to general wards who were at risk of MRSA colonization. Colonized patients were placed in contact isolation.Results.The mean rate of nosocomial MRSA infection decreased at Roper (0.76 cases per 1,000 patient-days BES and 0.45 per 1000 patient-days AES;P= .05) and at St. Francis (0.73 cases per 1,000 patient-days BES and 0.57 cases per 1000 patient-days AES;P= .35). Surveillance was cost-effective, preventing 13 nosocomial MRSA bacteremias and 9 surgical site infections, for a savings of $1,545,762.Conclusions.Targeted surveillance for MRSA colonization was cost-effective and provided substantial benefits by reducing the rate of nosocomial MRSA infections in a community hospital system.
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Katsura, Kouji, Yoshihiko Soga, Sadatomo Zenda, Hiromi Nishi, Marie Soga, Masatoshi Usubuchi, Sachiyo Mitsunaga, et al. "A cost-minimization analysis of measures against metallic dental restorations for head and neck radiotherapy." Journal of Radiation Research 62, no. 2 (February 23, 2021): 374–78. http://dx.doi.org/10.1093/jrr/rrab003.
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Abstract The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures: (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.
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Iskandar, Hary, Sabir Alwy, and Nurul Hudi. "KAJIAN YURIDIS PENGGUNAAN REKAM MEDIS UNTUK VERIFIKASI PEMBIAYAAN LAYANAN KESEHATAN." Medical Technology and Public Health Journal 2, no. 1 (August 24, 2018): 35–41. http://dx.doi.org/10.33086/mtphj.v2i1.315.
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The use of patient medical records for hospital payment claims is in essence contrary to the medical records confidentiality rules. This study aims to review the judicial use of medical records in the verification of health care financing in the era of national health insurance. This research uses descriptive study method with normative juridical approach. Qualitative data comes from literature review such as primary, secondary and tertiary law. This study indicates that verifiers with the status of health workers have the legal authority to use patient information in medical records as they relate to the profession. Medical secrets can be opened in the context of quality control and health care costs. Quality control through medical audit, and cost control with health service utilization. This study recommends that verifiers be selected from medical personnel and therefore have the authority to open a medical record.
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Iskandar, Hary, Sabir Alwy, and Nurul Hudi. "KAJIAN YURIDIS PENGGUNAAN REKAM MEDIS UNTUK VERIFIKASI PEMBIAYAAN LAYANAN KESEHATAN." Medical Technology and Public Health Journal 2, no. 1 (August 24, 2018): 35–41. http://dx.doi.org/10.33086/mtphj.v2i1.765.
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The use of patient medical records for hospital payment claims is in essence contrary to the medical records confidentiality rules. This study aims to review the judicial use of medical records in the verification of health care financing in the era of national health insurance. This research uses descriptive study method with normative juridical approach. Qualitative data comes from literature review such as primary, secondary and tertiary law. This study indicates that verifiers with the status of health workers have the legal authority to use patient information in medical records as they relate to the profession. Medical secrets can be opened in the context of quality control and health care costs. Quality control through medical audit, and cost control with health service utilization. This study recommends that verifiers be selected from medical personnel and therefore have the authority to open a medical record.
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Lebrett, Wendi G., Eric Roeland, Andrew Bruggeman, Heidi Yeung, and James Don Murphy. "Economic impact of palliative care among elderly cancer patients." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 91. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.91.
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91 Background: Randomized trials among advanced cancer patients demonstrate that early palliative care integration into usual oncology care reduces symptom burden, improves quality of life and caregiver outcomes, and may improve survival. The impact of palliative care on health economics remains poorly defined and reported cost savings are an unintentional consequence of providing care aligned with patient goals. This study determined the impact of palliative care on healthcare costs among elderly patients with advanced cancer. Methods: We conducted a matched case-control study among Medicare beneficiaries with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation. To determine the economic impact of a palliative care consultation we compared costs between cases and controls before and after the palliative care intervention. Costs included inpatient, outpatient, home health care, hospice, and medical equipment, and were adjusted to 2011 dollars. Results: Among the 2,576 patients in this study the total healthcare costs per patient in the 30 days before palliative care consultation was balanced between palliative care ($12,881) and non-palliative care control patients ($12,335). Palliative care intervention reduced total healthcare costs after the intervention. The total cost of care per patient in the 120 days after palliative care exposure was $6,880 compared to $9,604 for controls (28% decrease; p < 0.001). The economic effect of palliative care depended on timing of the consult. Palliative care consultation within 7 days of death decreased healthcare costs by $975, whereas palliative care consultation more than 4 weeks from death decreased costs by $5,362. Conclusions: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditures among advanced cancer patients. Furthermore, the cost reduction depends on timing of the palliative care consult.
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Jacobson, Peter D., Elizabeth Selvin, and Scott D. Pomfret. "The Role of the Courts in Shaping Health Policy: An Empirical Analysis." Journal of Law, Medicine & Ethics 29, no. 3-4 (2001): 278–89. http://dx.doi.org/10.1111/j.1748-720x.2001.tb00348.x.
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The transformation of health-care delivery from fee-for-service medicine to managed care represents a fundamental philosophical shift away from the prevailing medical ethos that the needs of the individual patient take precedence over competing social values, such as reducing health-care costs. In managed care, financial incentives to reduce health-care utilization may result in denying an individual’s claim for medical services.Litigation challenging managed care’s resource allocation decisions often presents the need to resolve conflicting social policy goals, such as the tension between an individual patient’s access to health care and a managed care organization’s (MCO’s) need to restrain costs. Conflicts may arise when a patient’s desire for unconstrained health care clashes with a provider’s and an insurer’s cost containment strategies. In turn, cost containment strategies may raise questions about restrictions on physician autonomy and conflicts among stakeholders for control over resource allocation decisions.
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Hakuz, Neris Musa Ahmad, Amani Mahmoud Al-Tarawneh, Baraah Walied Amireh, Husam Alhawari, Hiyam Al-Haqeesh, Jaafar Abu Abeeleh, Ahed J. Alkhatib, and Mahmoud A. Abu Abeeleh. "Designing An Intervention Program To Control Glucose Level In Intensive Care Unit (ICU) In King Hussein Medical Center, Royal Medical Services." European Scientific Journal, ESJ 12, no. 18 (June 29, 2016): 309. http://dx.doi.org/10.19044/esj.2016.v12n18p309.
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Controlling blood glucose level in ICU is one of the main priorities in ICU to decrease mortality rates and morbidity rates and to decrease the healthcare cost. The main objective of the present study is design and implement an intervention protocol in ICU. The method involved a suggested intervention protocol which was applied for 25 ICU patients and their findings were compared with 25 ICU patients in control group. Study findings showed that the intervention protocol was able to reduce mortality rates, positive blood cultures, decreased morning glucose level in the intervention group compared with control group. As a conclusion, controlling blood glucose level in ICU is considered an appropriate approach and leads to better outcome of the patients.
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Ramadhani, Rio Yus, Rizma Adlia Syakurah, and Mariatul Fadilah. "The Impacts of Medical Career Day to Medical Students' Interest to Pursue a Career in Public Health." Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education 6, no. 1 (March 29, 2017): 51. http://dx.doi.org/10.22146/jpki.25367.
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Background: Medical career day is one of the activities to introduce career options that exist and increase interest in a particular career. This study aims to determine the effect of material medical career day activities to increase the interest of medical students to pursue a career to the field of public health sciences.Method: This study is a quasi-experimental study with pretest-posttest control group design. The control group received counseling about the field of public health sciences, whereas the intervention group receive the same counseling accompanied by a description of the activity-based cost and opportunity cost in the field of public health sciences. The study population was 216 students of medical faculty batch 2014. Out of 216 students, 70 met the inclusion criteria, and only 36 who came to the activity. Data analysis was performed using paired t-test.Results: Thirty-six students came to the medical career day activities are divided into 2 groups: the first 18 people who come into the intervention group and 18 others to a control group. Increased interest in the control group (p=0.003) and increased interest in the intervention group was also significant (p=0.023).Conclusion: Material medical career day activities plus activity based cost and opportunity cost may increase the interest of students to pursue a career to the field of public health sciences.
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FRENZEN, PAUL D., ALISON DRAKE, and FREDERICK J. ANGULO. "Economic Cost of Illness Due to Escherichia coli O157 Infections in the United States." Journal of Food Protection 68, no. 12 (December 1, 2005): 2623–30. http://dx.doi.org/10.4315/0362-028x-68.12.2623.
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The Centers for Disease Control and Prevention (CDC) has estimated that Shiga toxin–producing Escherichia coli O157 (O157 STEC) infections cause 73,000 illnesses annually in the United States, resulting in more than 2,000 hospitalizations and 60 deaths. In this study, the economic cost of illness due to O157 STEC infections transmitted by food or other means was estimated based on the CDC estimate of annual cases and newly available data from the Foodborne Diseases Active Surveillance Network (FoodNet) of the CDC Emerging Infections Program. The annual cost of illness due to O157 STEC was $405 million (in 2003 dollars), including $370 million for premature deaths, $30 million for medical care, and $5 million in lost productivity. The average cost per case varied greatly by severity of illness, ranging from $26 for an individual who did not obtain medical care to $6.2 million for a patient who died from hemolytic uremic syndrome. The high cost of illness due to O157 STEC infections suggests that additional efforts to control this pathogen might be warranted.
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Uwaezuoke, SN, and HA Obu. "Nosocomial infections in neonatal intensive care units: Cost-effective control strategies in resource-limited countries." Nigerian Journal of Paediatrics 40, no. 2 (April 4, 2013): 125–32. http://dx.doi.org/10.4314/njp.v40i2.4.
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Background: Nosocomial infections or hospital-acquired infectionsconstitute a global health problem. They lead to significant morbidity and mortality in both developed and resource-limited countries. The neonatal intensive care unit (NICU) is a suitable environment for disseminating these infections; underscoring the need for preventive intervention measures.Objectives: This review aims to highlight the global burden of nosocomialinfections in neonatal intensive care units (NICUs), to discuss their epidemiology and clinical spectrum, as well as the costeffective control strategies in resource-limited settings.Sources: Sources of information were from Google searches andPubMed- linked articles using the key words- nosocomial infections,neonatal intensive care unit, control. Related articles from hard copiesof medical literature and journals were also gathered.Results: Although paucity of data exists on the incidence of nosocomialinfections in NICUs in developing countries, reports from developedcountries indicate a range of 6% to 25%. Much higher figures were noted in some developing countries. Several risk factors for nosocomial infections were identified but varied in different NICUs surveyed. Effective control strategies have been recommended but hand washing or hand hygiene appears universally applicable in both developed and resource-limitedcountries. Economic analyses of these strategies in developed countrieshave established their costeffectiveness while the adaptability of hand hygiene program to resource-limited settings has been demonstrated in a World Health Organization pilot study in sub- Saharan Africa.Conclusion: Hand washing or hand hygiene by health-care personnelremains the most important evidence-based and cost-effective controlstrategy for the spread of nosocomial infections in NICUs in resource-limited countries.Key words: nosocomial infections; neonatal intensive care unit;control.
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Yen, Christina, Paul Holtom, Susan M. Butler-Wu, Noah Wald-Dickler, Ira Shulman, and Brad Spellberg. "Reducing Clostridium difficile Colitis Rates Via Cost-Saving Diagnostic Stewardship." Infection Control & Hospital Epidemiology 39, no. 6 (April 3, 2018): 734–36. http://dx.doi.org/10.1017/ice.2018.51.
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We conducted a quality improvement project at a large public tertiary-care academic hospital to reduce reported hospital-acquired Clostridium difficile infection (CDI) rates. We introduced diagnostic stewardship and provider education, resulting in a 2-fold reduction in C. difficile nucleic acid amplification test (NAAT) orders and markedly lower hospital CDI rate.Infect Control Hosp Epidemiol 2018;39:734–736
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Cavalcante, M. D. A., O. B. Braga, C. H. Teofilo, E. N. Oliveira, and A. Alves. "Cost Improvements Through the Establishment of prudent Infection Control Practices in a Brazilian General Hospital, 1986–1989." Infection Control & Hospital Epidemiology 12, no. 11 (November 1991): 649–53. http://dx.doi.org/10.1086/646260.
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AbstractObjectives:To review procedures currently practiced in a Brazilian general hospital and to eliminate ineffective and inefficient practices. To measure the resulting cost improvements based on rigid hospital financing control.Design:Implementation of surveillance and control programs and prevalence surveys to detect ineffective and inefficient practices.Participants:The study institution is a 130-bed general care facility affiliated with the Brazilian federal government. There were approximately 4,600 admissions per year during the study period (1986- 1989).Results:Instituting infection control measures and eliminating ineffective practices resulted in the following: an overall decrease in wound infection rates from 24.4% in 1987 to 3.45% in 1989; a 71% reduction in the global incidence of infection in the intensive care unit; a 74% reduction in the surgical prophylactic use of antibiotics; and a total savings of approximately $2 million (US dollars).Conclusions:During the period from 1986 to 1989, the infection control committee was able to decrease the overall wound infection rate from 24.4% in 1987 to 3.45% in 1989. This eliminated special health problems and improved patient care and cost-effectiveness for our hospital.
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Brown, Charles H. "The Consultant Pharmacist's Role in Long-term Care Facilities." Journal of Pharmacy Practice 1, no. 3 (December 1988): 166–72. http://dx.doi.org/10.1177/089719008800100304.
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As the elderly portion of the US population continues to grow at an alarming rate, it is expected that the extent of their drug utilization will also escalate proportionately. The typical geriatric patient often presents with multiple medical disorders that are being treated with multiple drugs. With the elderly, as the number of medications increase numerically, the incidence of adverse drug reactions may increase exponentially. At times, one drug may be prescribed to treat the adverse effects of another medication. Studies show that the cost benefits of having consultant pharmacists conduct drug regimen reviews on patients in long-term care facilities resulted in a savings of $220 million. These cost savings resulted from the influence of consultant pharmacists decreasing the number of drugs per patient, amount of nursing time spent on drug administration, number of hospitalizations resulting from adverse effects, and overall cost of medical care. These data influenced the development of federal regulations that now require pharmacists to perform monthly drug regimen reviews on all patients residing in either intermediate or skilled nursing facilities. In addition to clinical drug therapy monitoring, the consultant pharmacist also participates in the infection control and pharmaceutical services committees and presents in-service training programs to the nursing staff. In performing various clinical and administrative functions, the consultant pharmacist must be able to work with other health care personnel in improving pharmaceutical services and patient care. As a result, there will be an even greater need in the near future for pharmacists who have been clinically trained to evaluate drug therapy in the elderly.
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Forsman, R. W. "Why is the laboratory an afterthought for managed care organizations?" Clinical Chemistry 42, no. 5 (May 1, 1996): 813–16. http://dx.doi.org/10.1093/clinchem/42.5.813.
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Abstract Market forces have dramatically influenced the environment in which healthcare is delivered, but these changes do not need to be interpreted negatively by community laboratorians. Only total vertical integration of laboratory medicine can control episode-of-care cost. Opportunities also exist for horizontal integration with community partners to provide geographical coverage and to compete favorably for managed care contracts. Lowering cost through "economies of scale" may apply to the procurement of supplies and equipment, but the delivery of services must be considered in the context of their overall effect on episode-of-care cost. Laboratory services may make up 5% of a hospital's budget but leverage 60-70% of all critical decision-making such as admittance, discharge, and medication. Laboratory outreach can help the medical center's financial stability by: (a) providing tests and service that can reduce or avoid a hospital stay; (b) using the additional volume of testing to distribute existing fixed costs and lower unit cost; and (c) adding revenue as a direct contribution to margin. To successfully compete for contracted managed care services, the laboratory must network with other providers to demonstrate comprehensive access and capacity. Community hospital laboratories perform 50% of all laboratory tests in this country and have adequate excess capacity to fulfill the remaining community needs.
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Ortolano, Girolamo A. "Potential for reduction in morbidity and cost with total leucocyte control for cardiac surgery." Perfusion 10, no. 5 (September 1995): 283–90. http://dx.doi.org/10.1177/026765919501000502.
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The economics of health care in the USA and abroad has caused a shift in the focus on therapeutic interventions that transcend issues of safety and clinical efficacy. Now, cost justification is emerging as a major consideration to influence clinical practice. This brief review of the medical literature attempts to identify leucocyte-mediated adverse reactions that develop in open-heart surgery, quantify the costs incurred to manage such reactions and infer the savings that may accrue by controlling the burden of leucocytes presented to the open-heart surgical patient using commercially available leucocyte reducing filtration technology.
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Bultas, Margaret W., and Amy Wehr. "What Is “Hot” and What Is Not: Thermometers and Fever Control." NASN School Nurse 36, no. 2 (January 15, 2021): 110–17. http://dx.doi.org/10.1177/1942602x20986134.
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The purpose of this article is to review and help identify the advantages and disadvantages of different types of thermometers available for use and to provide guidance on fever education for the otherwise healthy child in the community and school health population. The measurement of body temperature is an essential part of standard medical care that monitors patient status, response to treatment, and helps gauge the severity and progression of disease. There are multiple types of thermometers on the market and each has advantages and disadvantages related to infection control measures, cost, and ease of use. Digital thermometers provide quick accurate results and are cost-effective. However, noncontact forehead, tympanic, or temporal scanner may be a better option for some populations of students. The noncontact forehead scanner may be a better choice when large numbers of students need to be screened. After fever has been identified, parent education should be provided, including when to seek further care and comfort measures such as safe, effective antipyretic usage.
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Elkach, Toni. "Inventory Cost Reduction in the Perioperative Setting." Hospital Pharmacy 36, no. 5 (May 2001): 514–17. http://dx.doi.org/10.1177/001857870103600508.
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An inventory cost-reduction project for our operating room was undertaken to reduce excess inventory, increase inventory turnover, and eliminate unusable items. The operating area consisted of three departments with different inventory control potentials. In the anesthesia department, the targeted areas with corresponding results in inventory savings were: anesthesiologists' trays stock, $2344; refrigerated neuromuscular blockers, $2025; intravenous fluids and miscellaneous items, $2817; reduction of midazolam waste, $5907. Inventory reductions in the postanesthesia care unit and the operating room (the second and third departments) totaled $565 and $496, respectively. In addition, a yearly report run by the pharmacy and its purposes were discussed. These simple interventions led to inventory savings of $14,154. Projects now underway should lead to more impressive results in the near future.
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Dooling, Catherine, and Alan Wolff. "Limited Adverse Occurrence Screening: A Program with Significant Benefits for the Medical Record Department." Australian Medical Record Journal 22, no. 3 (September 1992): 98–101. http://dx.doi.org/10.1177/183335839202200305.
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Quality is a major issue in industry. However, the performance of hospitals is predominantly measured by quantity. There is little accurate measurement of, and control over, the quality of patient care provided. Traditional medical quality assurance methods do not meet the basic criteria of an effective control system as defined in management theory. Occurrence screening is a method of medical quality control that overcomes many of these deficiencies. It detects adverse patient occurrences by screening medical records using outcome criteria and selective medical record review. The implementation of an occurrence screening program using a small number of criteria and retrospective review in the Medical Record Department of a 200 bed base hospital is described. Screening has been integrated into daily work practices in an efficient and cost effective manner. Medical record staff have become more aware of the importance of complete documentation and the profile of the department in the hospital has risen. Significant patient care problems have been detected by the screening process.
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Nemetz, Peter N. "Closing the Loop: Facilitating the Use of Autopsy Information in Medical Decision Making and Managed Care." Biomedical Informatics Insights 1 (January 2008): BII.S899. http://dx.doi.org/10.4137/bii.s899.
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This paper advances the somewhat paradoxical hypothesis that the emergence of managed care which threatens to accelerate the decline of the autopsy may, in fact, offer an opportunity for its re-emergence as an important tool of quality and cost control. A simplified autopsy-based management information structure is proposed to close the loop where information currently gleaned from the autopsy is frequently unused or underutilized in medical decision making and managed care.
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Manzoor, Beenish S., Wei-Han Cheng, James C. Lee, Ellen M. Uppuluri, and Edith A. Nutescu. "Quality of Pharmacist-Managed Anticoagulation Therapy in Long-Term Ambulatory Settings: A Systematic Review." Annals of Pharmacotherapy 51, no. 12 (July 22, 2017): 1122–37. http://dx.doi.org/10.1177/1060028017721241.
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Objective: To perform a systematic review to evaluate the quality of warfarin anticoagulation control in outpatient pharmacist-managed anticoagulation services (PMAS) compared with routine medical care (RMC). Data Sources: MEDLINE, SCOPUS, EMBASE, IPA, CINAHL, and Cochrane CENTRAL, from inception to May 2017. Search terms employed: (“pharmacist-managed” OR “pharmacist-provided” OR “pharmacist-led” OR “pharmacist-directed”) AND (“anticoagulation services” OR “anticoagulation clinic” OR “anticoagulation management” OR “anticoagulant care”) AND (“quality of care” OR “outcomes” OR “bleeding” OR “thromboembolism” OR “mortality” OR “hospitalization” OR “length of stay” OR “emergency department visit” OR “cost” OR “patient satisfaction”). Study Selection and Data Extraction: Criteria used to identify selected articles: English language; original studies (comments, letters, reviews, systematic reviews, meta-analyses, editorials were excluded); warfarin use; outpatient setting; comparison group present; time in therapeutic range (TTR) included as a measure of quality of anticoagulant control; study design was not a case report. Data Synthesis: Of 177 articles identified, 25 met inclusion criteria. Quality of anticoagulation control was better in the PMAS group compared with RMC in majority of the studies (N = 23 of 25, 92.0%). Clinical outcomes were also favorable in the PMAS group as evidenced by lower or equal risk of major bleeding (N = 10 of 12, 83.3%) or thromboembolic events (N = 9 of 10, 90.0%), and lower rates of hospitalization or emergency department visits (N = 9 of 9, 100%). When reported, PMAS have also resulted in cost-savings in all (N=6 of 6, 100%) of studies. Conclusions: Compared with routine care, pharmacist-managed outpatient-based anticoagulation services attained better quality of anticoagulation control, lower bleeding and thromboembolic events, and resulted in lower health care utilization.
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Jacobs, Jake, and Susan Wyant. "Economic Examination of Cefoperazone Therapy." Drug Intelligence & Clinical Pharmacy 21, no. 4 (April 1987): 373–79. http://dx.doi.org/10.1177/106002808702100415.
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Medical records of 1137 patients from 35 hospitals were reviewed to examine the total cost of care for patients receiving cefoperazone as initial therapy compared to a control group receiving alternative agents. The direct costs of care measurable through a retrospective review of patient records were examined, including the cost of antibiotic acquisition, drug administration, laboratory testing, and room and board. Results of a regression analysis show that cefoperazone as initial therapy is associated with lower costs for all factors studied except acquisition cost. Antibiotic acquisition averaged $24 per patient mora for the cefoperazone group (p < 0.01). However, for cefoperazone patients drug administration was $63 less (p <0.0001), laboratory testing costs averaged $9 less (p = 0.22), and costs associated with room and board charges were $80 less (p = 0.40). Total costs averaged $3073 per cefoperazone patient and $3228 per control patient (p = 0.20). These data suggest that the previously accepted definitions of antimicrobial costs (i.e., cost per gram, cost per dose, cost per day) may no longer be adequate in this era of cost containment. In order to make sound clinical decisions with lowest total costs, practitioners should identify how and where costs are incurred.
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Click, Benjamin, Rocio Lopez, Susana Arrigain, Jesse Schold, Miguel Regueiro, and Maged Rizk. "Shifting Cost-drivers of Health Care Expenditures in Inflammatory Bowel Disease." Inflammatory Bowel Diseases 26, no. 8 (October 31, 2019): 1268–75. http://dx.doi.org/10.1093/ibd/izz256.
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Abstract Background Inflammatory bowel diseases (IBD) are costly, chronic illnesses. Key cost-drivers of IBD health care expenditures include pharmaceuticals and unplanned care, but evolving treatment approaches have shifted these factors. We aimed to assess changes in cost of care, determine shifts in IBD cost-drivers, and examine differences by socioeconomic and insurance status over time. Methods The Medical Expenditure Panel Survey (MEPS), a nationally representative database that collects data on health care utilization and expenditures from a nationally representative sample since 1998, was utilized. Adult subjects with IBD were identified by ICD-9 codes. To determine changes in per-patient costs or cost-drivers unique to IBD, a control population of rheumatoid arthritis (RA) subjects was generated and matched in 1:1 case to control. Total annual health care expenditures were obtained and categorized as outpatient, inpatient, emergency, or pharmacy related. Temporal cohorts from 1998 to 2015 were created to assess change over time. Per-patient expenditures were compared by disease state and temporal cohort using weighted generalized linear models. Results A total of 641 IBD subjects were identified and matched to 641 RA individuals. From 1998 to 2015, median total annual health care expenditures nearly doubled (adjusted estimate 2.20; 95% CI, 1.6–3.0) and were 36% higher in IBD compared with RA. In IBD, pharmacy expenses increased 7% to become the largest cost-driver (44% total expenditures). Concurrently, inpatient spending in IBD decreased by 40%. There were no significant differences in the rate of change of cost-drivers in IBD compared with RA. Conclusions Per-patient health care costs for chronic inflammatory conditions have nearly doubled over the last 20 years. Increases in pharmaceutical spending in IBD may be accompanied by reduction in inpatient care. Additional studies are needed to explore patient-, disease-, system-, and industry-level cost mitigation strategies.
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Guthrie, George E. "Money Talks." American Journal of Lifestyle Medicine 11, no. 5 (January 29, 2017): 373–74. http://dx.doi.org/10.1177/1559827616689557.
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The cost of providing medical care is increasing. The driving forces include inherent health care system conflicts of interest and financial incentives for procedures and technology. Effective lifestyle medicine principles are not easily adopted and rewarded in the present environment. Recent moves toward outcomes-based pay systems offer the potential to demonstrate the effectiveness of lifestyle medicine principles while bypassing many of the biases, application delays, and political machinations of the traditional randomized control trial methodology. The American College of Lifestyle Medicine is uniquely positioned to be a leading organization in improving health, enhancing patient experience, and reducing the cost of care.
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Boudreau, Denise M., Kam L. Capoccia, Sean D. Sullivan, David K. Blough, Allan J. Ellsworth, Dave L. Clark, Wayne J. Katon, Edward A. Walker, and Nancy G. Stevens. "Collaborative Care Model to Improve Outcomes in Major Depression." Annals of Pharmacotherapy 36, no. 4 (April 2002): 585–91. http://dx.doi.org/10.1345/aph.1a259.
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OBJECTIVE: To develop a pharmacist intervention to improve depression care and outcomes within a primary care setting. METHODS: Pragmatic, randomized trial of a clinical pharmacist collaborative care intervention versus usual care in a busy, academic family practice clinic. RESULTS: Seventy-four patients diagnosed with a new episode of major depression and started on antidepressant medications were randomized to enhanced care (EC) or usual care (UC) groups. EC consists of a clinical pharmacist collaborating with primary care providers (PCPs) to facilitate education, initiation, and titration of acute-phase antidepressant treatment to monitor treatment adherence and to prevent relapse. Control patients receive UC by their PCP. The main end point is reduction of depression symptoms over time as measured by the Hopkins Symptom Checklist (SCL-20). Other outcomes include the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) criteria for major depression, health-related quality of life measured by the Medical Outcomes Study Short Form 12 (SF-12), medication adherence, patient satisfaction, and healthcare utilization. The main end point and the cost of treating major depression will be used to estimate the cost-effectiveness of the collaborative care model. CONCLUSIONS: The study is a unique, ongoing trial that may have important implications for the treatment of depression in primary care settings as well as new roles for clinical pharmacists.
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Kobayashi, Kazuyoshi, Kei Ando, Masaaki Machino, Satoshi Tanaka, Masayoshi Morozumi, Shunsuke Kanbara, Sadayuki Ito, Taro Inoue, Naoki Ishiguro, and Shiro Imagama. "Trends in Medical Costs for Adolescent Idiopathic Scoliosis Surgery in Japan." Global Spine Journal 10, no. 8 (October 29, 2019): 1040–45. http://dx.doi.org/10.1177/2192568219886265.
Full textAbstract:
Study Design: A retrospective review of clinical data and costs was performed for surgeries for adolescent idiopathic scoliosis (AIS) conducted from 2008 to 2017. Objective: Cost containment and healthcare value have become focal points in Japanese health care policy. The purpose of the study was to investigate trends over time in medical costs for surgery for AIS. Methods: A total of 83 patients underwent surgery for AIS from 2008 to 2017 at our hospital. Clinical data and length of stay were collected, and medical costs for surgery, local bone grafting, fees per day, and surgical instruments were evaluated. Results: There were slight year-by-year decreases in fees per day and decreases in costs of surgical instruments. The average length of stay was 16.4 days and gradually decreased over time. In contrast, scoliosis surgery costs increased about 1.6 times in 10 years from $9515 to $15 130. Conclusion: The trends for decreases in fees per day and prices for surgical instruments reflect recent government medical cost control policies. The cost for scoliosis surgery is also defined by the government, and the increase over 10 years may reflect the perspective of valuing effective and advanced surgeries. This study of cost trends of operative spinal intervention provides an assessment of surgical benefit and is likely to influence health care costs.