Clinical performance and quality health care最新文献

{"title":"Predictors of functional status in patients in a chronic-care facility.","authors":"J Baigis,&nbsp;E Larson,&nbsp;M Y Haskey","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To identify those factors correlated with functional status levels (activities of daily living and mobility) in a chronically ill population in long-term care.</p><p><strong>Methods: </strong>Retrospective chart reviews were conducted over 3 months for information associated with functional status on all 220 patients in an urban extended-care facility. Independent variables included demographic variables, presence of selected medical conditions, current mental status, and baseline functional status on admission. Mean length of stay was 39 months. Multivariate analysis was performed to identify predictors of functional status.</p><p><strong>Results: </strong>Factors correlated with functional status levels for 217 patients included total score on admission functional status and total score on current mental status (both P < .0001). There were no significant differences in mean scores of total functional status by medical problem, age, gender, length of stay, condition, level of care, presence of infection, or use of psychotropic drugs.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"6 1","pages":"28-32"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21048497","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 use of total quality improvement techniques to determine risk factors for back injuries in hospital workers.","authors":"M Y Lin,&nbsp;J E Ahern,&nbsp;R R Gershon,&nbsp;M Grimes","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To identify the risk factors for back injuries among hospital employees using quality-management techniques.</p><p><strong>Methods: </strong>Data from employee-health records were collected from 1993 to 1995 on a total of 100 back injuries. The data were reviewed retrospectively for risk factors using quality-management techniques.</p><p><strong>Results: </strong>We identified two major categories of risk factors: administrative and environmental. The five most common causes of back injuries were as follows: inadequate or lack of proper training in body mechanics, not enough help in lifting, the load being lifted was too heavy, poor condition of the floor surface (slippery or uneven), and the patient was unable to help. The Workers' Compensation costs for the 100 back injuries was in excess of $600,000.</p><p><strong>Conclusion: </strong>Based on these findings, several preventive strategies are identified.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"6 1","pages":"23-7"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21048198","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":"Adverse selection at academic health centers.","authors":"S M Retchin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Market influences are placing many academic health centers (AHCs) in financial distress. Competitive forces threaten the core missions of AHCs, principally because of selective contracting, which has introduced price competition to medical care. This manuscript discusses the issue of adverse selection for AHCs, the probability that patients with higher levels of illness severity seek care at, or are referred to, AHCs. AHCs are particularly vulnerable to adverse selection because of their prominence as referral centers, their specialty composition, research expertise, and the socioeconomic status of patients located proximal to their centers. The adverse selection of AHCs increases the likelihood that health plans will trim their networks to exclude them. Health plans may still contract with AHCs for tertiary care only, but this will only worsen the adverse selection at AHCs.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"6 1","pages":"38-43"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21048196","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":"Variations in healthcare measures by insurance status for patients receiving ventilator support.","authors":"M A Schnitzler,&nbsp;D L Lambert,&nbsp;L M Mundy,&nbsp;R S Woodward","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To examine differences in healthcare delivery by expected health insurance status for hospitalized patients in diagnosis-related group (DRG) 475, respiratory system diagnoses requiring intubation and continuous ventilator support.</p><p><strong>Design: </strong>A survey, derived from the Healthcare Cost and Utilization Project interstate database, of the care delivered to 21,149 adult patients in DRG 475 and hospitalized in one of 718 acute-care hospitals in nine states. Multivariate analysis was performed, controlling for demographic and hospital factors.</p><p><strong>Results: </strong>Patients insured by health maintenance organizations (HMOs) had significantly lower rates of inpatient mortality (odds ratio [OR], 0.84; 95% confidence interval [CI95], 0.73-0.96), 14.3 more procedures performed (CI95, 11.5-17.2), 7.0% shorter hospitalizations (CI95, 12.5-1.6), and 5.2% higher charges (CI95, 0.4-10.0) than those with traditional private insurance. In addition, patients insured by Medicaid had 3.5% more procedures performed (CI95, 1.6-5.4), 10.4% longer lengths of hospitalization (CI95, 6.7-14.0), and 13.8% higher charges (CI95, 10.6-17.0) than those with traditional private insurance. Finally, the uninsured had significantly lower rates of inpatient mortality (OR, 0.87; CI95, 0.77-0.99), 8.5% more procedures performed (CI95, 6.0-11.1), 16.5% shorter hospitalizations (CI95, 21.5-11.6), and 13.4% lower charges (CI95, 17.8-9.0) than those with traditional private insurance.</p><p><strong>Conclusion: </strong>Variations in healthcare measures by insurance status for this DRG emphasize the importance of more careful analyses of insurance categories as a determinant of healthcare access and outcomes. Expected insurance status was an independent predictor of cost. Private insurance and HMO populations differed significantly in outcome and cannot be considered equivalent.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"6 1","pages":"17-22"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21048493","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 clinical decision process model for evaluating vancomycin use with modified HICPAC guidelines. Hospital Infection Control Practice Advisory Committee.","authors":"C Salemi,&nbsp;L Becker,&nbsp;R Morrissey,&nbsp;J Warmington","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate a clinical decision process model for the appropriateness of vancomycin use, using modified Hospital Infection Control Practice Advisory Committee (HICPAC) guidelines.</p><p><strong>Design: </strong>All nondialysis vancomycin use was reviewed using the retrospective chart review method. The HICPAC guidelines were modified to distinguish between documented and suspected infections and appropriateness of vancomycin use initially and after 3 days of therapy. Data were collected on both vancomycin-use orders and vancomycin-use days.</p><p><strong>Setting: </strong>446-bed health maintenance organization teaching hospital.</p><p><strong>Results: </strong>758 uses of vancomycin from 1993 through 1995 were evaluated using the modified HICPAC guidelines. Initial use was appropriate in 71% of the cases, with 26% used for documented infections and 74% for suspected infections. Of the 536 orders of initial appropriate use, 176 courses of treatment with vancomycin were discontinued appropriately within 3 days. Ongoing use evaluation after 3 days revealed appropriate use in 45%, inappropriate ongoing use in 25%, and empirical ongoing use in 30% of the cases. There were adequate clinical or laboratory data available in 70% of cases after 3 days to discontinue vancomycin or to reclassify from suspected to documented infections or indications. Vancomycin-use evaluation solely after 3 days would not have disclosed 537 initial inappropriate vancomycin-use days, which were 44% of the total inappropriate use days.</p><p><strong>Conclusions: </strong>Comprehensive evaluation of vancomycin use with HICPAC guidelines should include a modification to encompass initial and 3-day reevaluation, because most initial use is for suspected, and not documented, infections. HICPAC guidelines do not address the issues of differentiating suspected from documented infection indications or ongoing empirical use. The clinical decision process model is a framework for documentation and data collection for use evaluation and addresses issues not covered in HICPAC vancomycin guidelines. This model could be used by other medical centers for evaluation of vancomycin or other antibiotics.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"6 1","pages":"12-6"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21048495","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":"Where's the evidence? How to find clinical-effectiveness information.","authors":"J Glanville","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The National Health Service Centre for Reviews and Dissemination is the sibling organization to the UK Cochrane Centre, which is part of the Cochrane Collaboration. The two centers form part of a UK-government-funded initiative to provide information for research-based health care in a variety of ways, ranging from databases to printed publications. The new evidence-based culture in health care presents new challenges to healthcare professionals, who have discovered that systematic reviews and evidence-based guidelines are useful tools in the struggle to stay abreast of published research. However, the numbers of reviews and guidelines are increasing, and keeping track of them presents a new problem. Keeping up-to-data with research is a continuing issue because of constraints in time, resources, and poor search interfaces. There also are challenges in acquiring or developing skills, such as information retrieval to locate research, as well as critical appraisal abilities to evaluate research. However, there are many existing resources that can supply information on clinical effectiveness and many developing services that are trying to provide access to research information in timely and intuitive ways.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"6 1","pages":"44-8"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21048501","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":"Staphylococcus aureus bacteremia: the cost-effectiveness of long-term therapy associated with infectious diseases consultation.","authors":"J Lundberg,&nbsp;M D Nettleman,&nbsp;M Costigan,&nbsp;S Bentler,&nbsp;J Dawson,&nbsp;R P Wenzel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the cost-effectiveness of long-term therapy for Staphylococcus aureus bacteremia and to determine if an infectious diseases consultation affected the duration of therapy.</p><p><strong>Methods: </strong>A decision analysis was performed based on data from the literature. To determine if consultation was related to therapy duration, a retrospective cohort study was performed using tightly matched pairs.</p><p><strong>Results: </strong>The excess cost per life saved by long-term antibiotics was $500,000. The excess cost per life-year saved was $18,000. Nine pairs were matched. Patients who received consultation were more likely to receive long-term therapy than controls (median 41 days vs 15 days for controls, P = .04).</p><p><strong>Conclusions: </strong>The estimated cost per life-year saved by long-term therapy was similar to other accepted medical interventions. Infectious diseases consultation can encourage prolonged duration of antibiotic therapy for S aureus bacteremia.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"6 1","pages":"9-11"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21048197","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":"Patient satisfaction--what's new?","authors":"M D Nettleman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The past decade has seen increased attention focused on patient satisfaction; however, there are no universally accepted means of measuring patient satisfaction. A review of recent studies reveals some interesting findings. Satisfaction has been shown to be related directly to patient expectations; however, intuitive physician judgments about patient expectations may not correlate with true expectations. Further, patient satisfaction may not correlate with the level of clinical outcome. Recent advances have changed our understanding of this complex field.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"6 1","pages":"33-7"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21048201","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":"Increased nursing-time requirements due to pressure sores in long-term-care residents in Quebec.","authors":"W D'hoore,&nbsp;A L Guisset,&nbsp;C Tilquin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To test the hypothesis that pressure sores significantly influence the nursing workload, after taking confounding factors into account, i.e., patients' characteristics simultaneously associated with the occurrence of pressure sores and the nursing-time requirements.</p><p><strong>Design: </strong>Retrospective analysis of administrative data for a cohort of long-term-care residents (Planification Informatisée des Soins Infirmiers Requis database). Two methods were used to control for confounding factors: analysis of covariance and sample restriction.</p><p><strong>Setting: </strong>Long-term-care institutions of Quebec, except exclusively psychiatric and private centers.</p><p><strong>Patients: </strong>Data was available for the 13,555 residents aged 65 or more whose health status changed during the year 1993-1994.</p><p><strong>Results: </strong>Prevalence of sores was 4.0% (544/13,555). Before any adjustments were made, residents with pressure sores needed, on average, 63 minutes more than the residents without pressure sores. Two confounding factors were identified: dependence in the activities of daily living and physical mobility. Analysis of covariance showed that the adjusted increase in daily nursing care was 19 minutes. In the second analysis, a restricted homogeneous sample for the confounding factors was used (5,849 patients, including 414 patients with pressure sores). According to this method, the adjusted increase in daily nursing care was 17 minutes. In both analyses, the increase was noticeable in the spheres of alimentation, mobilization, and treatments.</p><p><strong>Conclusions: </strong>The presence of pressure sores significantly influences the nursing workload, even after eliminating the influence of confounding factors. Because nursing time can be translated into cost, effective prevention strategies and strategies of reducing the costs of treating sores should be analyzed.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"5 4","pages":"189-94"},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21047198","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 modification of physician practice patterns.","authors":"S M Retchin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>While physicians are directly responsible for only a small proportion of healthcare expenditures, their decisions influence the majority of medical costs. Because practice variations among physicians have been demonstrated abundantly, strategies to modify practice patterns have evolved. This article addresses the different factors that influence variations in patterns of practice, including physician characteristics, knowledge, beliefs, and attitudes. In designing programs to modify practice patterns, educational efforts, along with practice guidelines and feedback, all have been used. Although there are mixed results for each, the use of opinion leaders and the timing of interventions proximal to practice decisions are important. The costs and benefits of interventions are discussed as a method for assessing the utility of different programs to modify practice patterns.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"5 4","pages":"202-7"},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21047191","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}