Journal of the Society for Health Systems最新文献

{"title":"A statistical evaluation of mammography: crucial questions for health systems.","authors":"C J Watson,&nbsp;S A Chesteen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article reviews data on incidence and mortality rates from breast cancer and provides the results from applications of Bayes' Theorem and a test of homogeneity to investigate the efficacy of mammographic screening for breast cancer. The results of our analyses indicate that the accuracy and effectiveness of mammographic screening for breast cancer are debatable. Consequently, we identify crucial unanswered questions for health systems about the heavy reliance on mammography. We recount the current recommendations, standards of practice, and utilization of mammography for breast cancer screening. Finally, we question the language used to describe the conclusions of these studies.</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"4 1","pages":"68-79"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19256922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of hospital industrial engineering: from scientific management to total quality management.","authors":"V K Sahney","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Industrial engineering applications in the hospital industry first began in 1910. This paper traces the evolution of hospital industrial engineering in five distinct phases. For each of the major phases, this paper presents the contributions made by industrial engineers. Many of the techniques advocated by industrial engineers are now being taught to hospital employees as hospitals introduce total quality management (TQM) within the health-care industry. TQM introduction has meant a new role for industrial engineers, as that of a teacher, coach, and a facilitator. This new role holds much promise for the improvement of quality and productivity in health care.</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"4 1","pages":"3-17"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19256919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A successful physician-led multidisciplinary approach to process improvement for inpatient chemotherapy.","authors":"L B Rupp,&nbsp;T J Doyle","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In 1991, Henry Ford Hospital established a physician-led, multidisciplinary chemotherapy DRG task force charged with examining and improving the clinical and support processes relating to inpatient chemotherapy. While the goal of this effort was to improve cost management, quality improvement philosophy and methods were applied. This task force developed two short-stay protocols, reducing the length of hospitalization from three days to one for high-dose cisplatin regimens, and from five to only two days for combined chemotherapy/radiation therapy regimens. This article shares insights regarding the types of improvements and methods that were used, the effective involvement of physicians, and the use of administrative and staff support to accelerate the improvement effort and leverage clinicians' time.</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"4 1","pages":"18-33"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19255690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-hospital mortality and morbidity variation in Pennsylvania.","authors":"R C Bradbury,&nbsp;J H Golec,&nbsp;F E Stearns,&nbsp;P M Steen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 1986 Pennsylvania law requires the public disclosure of hospital mortality and morbidity rates. This study of hospital admissions in 1989 and 1990 examines the variation in these health-outcome indicators for the 10 most frequently occurring DRGs in the adult medical service in a sample of 20 Pennsylvania hospitals. These mortality and morbidity rates are adjusted for admission severity, DRG, age, and sex, using a logistic regression model. The null hypothesis of no significant variation among hospitals is rejected by the statistically significant (p < 0.01) results of a likelihood ratio test on the hospital variables in logit models for both mortality and morbidity. Test results also show that 4 (20 percent) of 20 hospitals have statistically significant (p < 0.05) adjusted mortality rates, and 4 (20 percent) of 20 hospitals have significant morbidity rates. Such information may impact hospital management practices in a variety of ways.</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"4 1","pages":"48-67"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19256921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician-Directed Diagnostic and Therapeutic Plans: a quality cure for America's health-care crisis.","authors":"C Musfeldt,&nbsp;R I Hart","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The most effective way to improve quality is to reduce variation in the processes of providing a service. Physician-Directed Diagnostic and Therapeutic (PDDT) Plans are a proven methodology for reducing variation in clinical processes and improving the quality of care. A major part of the PDDT Plan process is the development of a critical pathway. Critical pathways are an application of Total Quality Management (TQM) principles to clinical care which have provided clear, tangible results in those hospitals committed to this process. These pathways define the processes, timelines and responsibilities associated with the patient's clinical needs from preadmission to post discharge. Representatives of the various health-care professions involved in treating the specified patient populations work together, led by a physician, to define the processes of care. When completed, everyone involved in treating the patient understands what is to be done, by whom, and when. The pathways allow clinicians to plan ahead and let the patient and family know what to expect. Through establishing standards of care, these critical pathways also reduce the uncertainty of treatment decisions and free physicians from having to practice defensive medicine, and thus reduce cost. While the most visible outcome of this process is the actual PDDT Plan, it is not necessarily the most important. The very process of designing the pathway improves intra- and interdisciplinary communication, and fosters teamwork.</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"4 1","pages":"80-8"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19256923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RURALSIM: the design and implementation of a rural EMS simulator.","authors":"L J Shuman,&nbsp;H Wolfe,&nbsp;M J Gunter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Why were these applications of simulation technology unsuccessful? Parochialism, the volunteer nature of EMS planning, and limited regional commitment to resolve such complex problems at the local level all combined to present significant barriers to implementation. Political factors which posed the most significant barriers included: conservative attitudes concerning the funding and regulation of EMS activities by local governments; general opposition to governmental intervention in the private sector; strong resistance to mandatory standards for EMS; jurisdictional disputes between EMS-related agencies; lack of cooperation between the local governments; competition between prehospital-care providers and between hospitals; overemphasis on local jurisdictional boundaries in the planning and delivery of services; and the allocation of EMS resources, such as ambulances, according to political priorities, rather than more objective criteria. Based upon the results of the four field tests, the following observations are relevant: 1. RURALSIM is a very complex simulator. While every effort was made to assure generalizability, for any given situation, it required extensive modification and tailoring. The result was a model capable of handling a rather diverse set of situations, but one that could not be turned over to the general public for use. To implement RURALSIM required the participation of the University of Pittsburgh research team. The newer simulation languages now available alleviate this problem somewhat. 2. RURALSIM's complexity was needed to examine the different alternatives proposed by local planners. It was particularly needed in order to simulate each region's existing system. Such \"base-line\" simulations were required in order to achieve face validity and provide a basis for comparing alternatives. 3. With hindsight, a major weakness was the limited amount of face-to-face interaction between local planners and decision makers and the University of Pittsburgh staff. Only two trips to the region were budgeted. This proved to be insufficient and placed too much responsibility for model interpretation and analysis on the local contractors. 4. In none of the four test sites did the contractors and/or local health planners have the authority, influence and/or incentives necessary to develop regional EMS systems. In particular, none of the contractors were in the position to be decision makers, nor was there ever only one decision maker. This is not a criticism of the contractors, who did their best under difficult circumstances. Rather, it is a criticism of the state of eMS system development in the US in the early 1980s. There were few examples where regional systems developed successfully in the face of serious opposition from local interests.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"3 3","pages":"54-71"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12562902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital payment based on diagnosis-related groups.","authors":"R B Fetter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Prospective Payment System (PPS) used by Medicare to pay hospitals is described. As Diagnosis-Related Groups (DRGs) are central to this system, they are described in some detail. While the results achieved by PPS have been impressive, opportunities to both improve and extend the approach are present. Problems with the approach are described, together with alternatives to direct payment.</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"3 4","pages":"4-15"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12463442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASTERIKS--a management game for hospitals.","authors":"S Schwarz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>ASTERIKS is a PC-based management game dealing with scheduling and sequencing operations in hospital departments. The game uses a process-oriented approach for simulation. The purpose of the game is to support training of hospital staff in this field as a necessary prerequisite for economic efficiency and for patient and staff satisfaction. The players have to first define their goals. During the game the teams can lay down operational routines in their hospitals, change their appointment systems and make staff and investment decisions. ASTERIKS' interactive design allows for immediate feedback to the players once the planning and simulation phases have been finished. Results include patients and staff satisfaction, treatment quality, utilization of resources and the length of stay.</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"3 3","pages":"5-14"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12563551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systems approaches in emergency medical services: the history, the impact, and the future.","authors":"J A Myrick","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Systems approaches have been important in planning and evaluating emergency medical services (EMS) systems. However, maximal use of systems approaches are limited by small political boundaries, the lack of user-friendly systems tools, and the need for EMS planning staffs who are familiar with these systems tools. Developing technology, particularly communications, will continue to have a great impact on EMS delivery. In addition, the need is seen for continuing advances in systems concepts, and in particular, the promotion and incorporation of health and prevention of injury as systems concepts.</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"3 4","pages":"37-47"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12463441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The origins of hospital microcosting.","authors":"L J Shuman,&nbsp;H Wolfe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This paper begins with a definition of microcosting, including the specification of design criteria and a general model framework. The necessity for micro- as opposed to macro-costing is discussed. Examples of microcosting systems are provided. Relative value scale and case-mix alternatives to microcosting are presented.</p>","PeriodicalId":77231,"journal":{"name":"Journal of the Society for Health Systems","volume":"3 4","pages":"61-74"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12463444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}