Journal of hospital management and health policy最新文献

{"title":"Cost of inappropriate use of intravenous N-acetylcysteine for acetaminophen toxicity","authors":"A. Dalabih, C. Cox, Jordan Anderson","doi":"10.21037/JHMHP-20-87","DOIUrl":"https://doi.org/10.21037/JHMHP-20-87","url":null,"abstract":"study Background: Intravenous (IV) N-acetylcysteine (NAC) is the treatment of choice for acetaminophen (APAP) toxicity. The initiation of NAC should be based on specific criteria depicted by the Rumack-Matthew Nomogram. The treatment requires hospital admission and frequent laboratory tests, making it a costly treatment. The purpose of this analysis is to determine the financial impact of inappropriate IV NAC use for APAP toxicity. Methods: This single-center, retrospective chart review included adult and pediatric subjects who received at least one dose of IV NAC at a tertiary academic medical center for acute and chronic APAP toxicity. Primary objective; determine the financial impact of inappropriate use of IV-NAC concerning compliance with the nomogram when initiating the treatment. Secondary objectives; missed cost-saving opportunities resulting from non-compliance with treatment regimen recommendations for maximum doses, and the number of dosing cycles. Cost analysis was completed by the hospital billing department and utilized true cost charges. Total cost of hospitalization was calculated, and total medication charges were evaluated separately using the hospital’s group purchasing organization (GPO) pricing. Results: Ninety-six subjects were included in the final analysis. A potential savings of $253,891.85 United States Dollars (USD) could have been realized if the administration guidelines were followed. NAC was inappropriately initiated in 20 of the 56 subjects (35.7%) with an acute, known time of APAP ingestion. Of the 346 total doses of IV NAC administered throughout the study (n=47, 13.6%) exceeded manufacturer maximum suggested recommendations. The higher doses were all related to subjects with body weight higher than 100 kg. Conclusions: The results from this study show a high financial cost on the healthcare system when providers inappropriately initiate IV NAC for acute APAP toxicity. Healthcare systems should follow the administration guidelines of IV NAC to decrease overall expenses and potential adverse effects. Utilizing order sets to guide appropriate therapy initiation and/or discontinuation is advisable. A careful review of pertinent laboratory values and collaboration with regional Poison Control Centers to determine treatment duration may also be warranted.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47038382","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 value-based purchasing, market competition, and outpatient imaging efficiency","authors":"Mei Zhao, H. Hamadi, D. R. Haley, K. Pray, Paul A. Heyliger-Fonseca, A. Spaulding","doi":"10.21037/JHMHP-20-127","DOIUrl":"https://doi.org/10.21037/JHMHP-20-127","url":null,"abstract":"Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, FL, USA; Management Engineering and Internal Consulting, Mayo Clinic in Rochester, Rochester, MN, USA; Defense Health Agency Supporting Navy, San Antonio, TX, USA; Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA Contributions: (I) Conception and design: M Zhao, DR Haley, A Spaulding; (II) Administrative support: K Pray, DR Haley, P Heyliger-Fonseca; (III) Provision of study materials or patients: M Zhao, HY Hamadi, A Spaulding, P Heyliger-Fonseca; (IV) Collection and assembly of data: HY Hamadi, M Zhao, A Spaulding, K Pray; (V) Data analysis and interpretation: M Zhao, HY Hamadi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Hanadi Y. Hamadi, PhD, MHA. Associate Professor, Department of Health Administration, Brooks College of Health, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224-7699, USA. Email: h.hamadi@unf.edu.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47209049","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 and family advisory councils (PFAC) feedback as the voice of health care consumers","authors":"Cortney D Forward, Cynthia J. Sieck","doi":"10.21037/jhmhp-20-112","DOIUrl":"https://doi.org/10.21037/jhmhp-20-112","url":null,"abstract":"Background: Throughout the U.S., healthcare organizations continuously find ways to incorporate patient feedback with efforts to advance the delivery of patient-centered care. Patient and family advisory councils (PFACs) can be used as a strategy to better understand and honor the patient experience and improve care delivery thanks to patient input to obtain patient perspectives. The importance of formal efforts to incorporate the patient perspective is highlighted by the Comprehensive Primary Care Plus (CPC+) program implemented by the Centers for Medicare and Medicaid Services which requires organizations to establish PFACs to receive funding. Site support for PFACs included a patient experience manager who oversaw recruitment and facilitated each clinic’s council meetings. Other support personnel consisted of the practice manager, physicians, care coordinators, and advanced practice providers. This study employed a leadership framework to better understand how health care organizations use PFACs to discover and define patient/family advisors perspectives and how they can be related to different styles of leadership continually evolving. This study surrounding the experiences of patient/family advisors and PFACs can be used for further research and to gain a better understanding of this topic. This research presented patient/ family advisors experiences, working together on patient family advisory councils with health care leaders, staff, providers, and managers, signaling the distinctive experiences of these participants which merits additional examination. There is further need for a meaningful discussion concerning the distinctive way doctors, providers and patients perceive the importance and meaning of medical encounters and patient and family engagement strategies.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42173791","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":"Technological advances to enhance recovery after cardiac surgery","authors":"K. Lobdell, J. Appoo, G. Rose, B. Ferguson, S. Chatterjee","doi":"10.21037/JHMHP-20-114","DOIUrl":"https://doi.org/10.21037/JHMHP-20-114","url":null,"abstract":"Surgery, and especially cardiac surgery, is common, costly, and entails considerable risk. Significant progress has been made in recent years to improve quality, promote patient safety, and increase value and cost-effectiveness in surgical care. Enhanced Recovery After Surgery (ERAS) initiatives are increasing in popularity, improving outcomes, and enriching patient satisfaction. First developed for abdominal surgical cases, ERAS has increasingly established itself across all surgical subspecialities, including cardiac surgery. ERAS focuses on evidence-based initiatives in the preoperative, intraoperative, and postoperative phases of care to promote patient well-being and efficient care. The deliberate, judicious incorporation of technology into surgery and the periprocedural home has tremendous, revolutionary potential in all phases of care and is consistent with ERAS principles. This technology can be harnessed by physicians and the care provider team, the healthcare system, and perhaps most importantly, by patients themselves to lead to a higher level of engagement. We will explore technology's transformational capability by concentrating on cardiac surgery because of its prevalence, costs, risks, and contribution to the healthcare system's bottom line. In addition, the role that ERAS combined with technology can play in a constructive manner will be important. We discuss the disruptive effect that the COVID-19 pandemic offers to accelerate these developments. While the human cost of the pandemic has been staggering, in the post-COVID world, the lessons learned can be vital. Finally, we seek to show that the opportunities technology provides are closely related to what both patients and the physician and provider teams want. As technology inevitably becomes more integrated into healthcare, the ability to harness technology to maximize patient outcomes and well-being while promoting more efficient healthcare delivery will be critical. © Journal of Hospital Management and Health Policy. All rights reserved.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48543355","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":"Challenges in the implementation of electronic systems for patient report of symptoms in oncology: a scoping review.","authors":"Stacey Crane, Karen DiValerio Gibbs, Rebecca Nosich, Yijiong Yang, Elizabeth Pawelek","doi":"10.21037/jhmhp-20-108","DOIUrl":"10.21037/jhmhp-20-108","url":null,"abstract":"<p><strong>Background: </strong>Under-recognition and under-treatment of symptoms are prevalent throughout the health care system in the United States. While the reasons for this are complex, it is widely recognized that electronic symptom reports can improve clinicians' ability to manage symptoms. However, electronic symptom reporting has yet to be widely implemented. Electronic systems are most effective when tailored to the specific patient population or clinical setting. For example, numerous oncology-focused electronic symptom reporting systems have been developed for patients with cancer undergoing treatment in the United States. The objective of this scoping review was to identify challenges that arose in the implementation of electronic systems for patient-reported symptoms in oncology clinical practice, and approaches that were taken or recommended to overcome those challenges.</p><p><strong>Methods: </strong>This scoping review involved comprehensive searches of Medline, CINAHL, and the Cochrane Central Register of Controlled Trials, which yielded 3,133 articles. Following screening, 20 research studies met the inclusion criteria and were included in this review. Data were systematically extracted from the articles using a qualitative content analysis.</p><p><strong>Results: </strong>Challenges identified were thematically categorized as technical issues, system usability issues, patient lack of comfort/knowledge of technology, incomplete/missing data, lack of patient use of the system, other patient issues, difficulties timing completion with clinical processes, lack of clinic staff involvement/engagement, and lack of clinician comfort/knowledge regarding the use of patient-reported outcome data.</p><p><strong>Discussion: </strong>The findings of this review highlight challenges that need to be addressed when implementing an electronic symptom reporting system for patients with cancer, and potential strategies for overcoming these challenges. This review may help hospital administrators and clinicians prepare for and improve the implementation of electronic symptom reporting systems into clinical practice, thereby providing evidence to enable their broader use.</p>","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11198977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43912603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a Key Drivers Diagram in preparation for COVID-19 at an urban, academic anesthesiology department","authors":"K. Parr, Geoffrey Ho, Michelle S. Burnette, James Gould, B. Petinaux, M. Sherman, Jeffrey S. Berger","doi":"10.21037/jhmhp-21-5","DOIUrl":"https://doi.org/10.21037/jhmhp-21-5","url":null,"abstract":"Background: The 2019 novel coronavirus pandemic has had a significant impact on anesthesiology practice globally. Its high infectivity and severity of onset has led to numerous examples of healthcare systems being overwhelmed, especially at its incipience. Drawing on experiences from previous pandemics, we anticipated that our Anesthesiology Department would be faced with unique challenges due to our proximity to airway maneuvers. We set out to intentionally strategize a quality improvement framework with which to guide our departmental response. Methods: We employed a Key Drivers Diagram (KDD) model to strategically account for the numerous novel quality improvement measures implemented simultaneously in response to the pandemic. Having identified areas of interest, measurable indices were identified, and dynamic progress assessed using run charts. These were (I) protect patients and staff, (II) keep up-to-date with evolving evidence, (III) maintain communication with department, (IV) keep staff engaged, and (V) align departmental goals with institutional aims. Results: Positive trends in staff engagement were identified across participation in educational activities such as guideline development, grand round attendance, and interdepartmental meetings. Conclusions: The KDD provided a valuable framework for managing parallel quality improvement processes. It enabled leadership to identify needs, measure adequacy of response and implement changes in a rapidly evolving environment. © Journal of Hospital Management and Health Policy. All rights reserved.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44491609","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":"Participation in delivery system reform programs and U.S. acute care hospital integration into behavioral health","authors":"Larry R. Hearld, R. Kelly","doi":"10.21037/jhmhp-21-45","DOIUrl":"https://doi.org/10.21037/jhmhp-21-45","url":null,"abstract":"Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Healthcare Administration and Policy, School of Health Sciences, University of New Haven, West Haven, CT, USA Contributions: (I) Conception and design: LR Hearld; (II) Administrative support: RJ Kelly; (III) Provision of study materials or patients: LR Hearld; (IV) Collection and assembly of data: LR Hearld; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors. Correspondence to: Larry R. Hearld, PhD. Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, SHPB 559, 1720 2 Ave South, Birmingham, Alabama, USA. Email: lhearld@uab.edu.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43364558","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":"An examination of the sustainability of the CXO advantage in U.S. hospitals","authors":"Seongwon Choi, K. Hearld, Alisha Singh, Geoffrey A. Silvera, W. Breen, N. Borkowski","doi":"10.21037/jhmhp-21-67","DOIUrl":"https://doi.org/10.21037/jhmhp-21-67","url":null,"abstract":"","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47044825","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":"Reducing wait times to surgery—an international review","authors":"Tania Stafinski, F. Nagase, M. Brindle, Jonathan White, Andrea Young, S. Beesoon, S. Cleary, D. Menon","doi":"10.21037/jhmhp-21-96","DOIUrl":"https://doi.org/10.21037/jhmhp-21-96","url":null,"abstract":": This study aimed to describe approaches used in Canada and internationally, targeting wait times from the decision to treat to surgery (wait time 2). Access to optimal care at the right place and at the right time remains a top priority for patients, healthcare providers and policymakers. Interviews with key informants from 14 countries and a scoping review were conducted to identify approaches targeting wait times. During interviews, participants were asked about their experiences with different approaches in their jurisdictions. The scoping review adhered to published guidelines and captured both peer-reviewed and grey literature. Results were compiled into tables and synthesized based on a conceptual framework describing the main policy types for improving wait times. The study included 32 interviews, 92 peer-reviewed studies and 242 documents from the grey literature. Information spanned 17 countries across multiple surgical areas. In total, 33 approaches were identified, with the majority [24] targeting the supply-side. Fifteen approaches had consistent or limited but promising evidence supporting their effectiveness. Approaches can impact wait times 2 by targeting demand, supply or both. Successful strategies require the implementation of multiple approaches, collaborations and investments. This study may help organizations plan and implement policies intended to improve timely access to surgical care.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45818396","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":"Artificial intelligence in healthcare-opportunities and challenges","authors":"S. Reddy, J. Winter, S. Padmanabhan","doi":"10.21037/JHMHP-21-31","DOIUrl":"https://doi.org/10.21037/JHMHP-21-31","url":null,"abstract":"The term artificial intelligence (AI) evokes various responses amongst healthcare professionals, researchers and consumers (1). For some, AI could be panacea to all the problems ailing the healthcare sector and yet for others, a fad to be quickly dismissed. The truth is somewhere in between considering the efficacy of machine learning, a subset of AI, has been demonstrated in different areas of medicine with improved diagnosis and treatment being made possible (2). In other instances, AI has been found to useful in drug discovery, infectious disease surveillance and even in aiding efficient healthcare administration. Also, there has been increasing support from governments and the private sector in funding AI in healthcare research and development with a growing number of AI enabled medical software being approved for use in the market (3). However, AI as a new technology, especially so in the realm of medicine, has to be carefully evaluated for its safety and efficacy in achieving its intended outcomes (4). There is requirement for some preparatory work and laying out the ground for integration of AI in routine clinical workflows, while supporting more research and development of AI in healthcare applications. In this special edition, researchers and clinicians from across the world outline the scale of the use of AI in various contexts and key issues to consider in implementing AI in healthcare strategies. Covered in this edition is the ability of AI to enable precision medicine, issues in hospitals using AI for strategic decision making, how AI has been used in the Indian healthcare sector, the role of AI in managing respiratory diseases, the ability of AI to improve the quality of healthcare, why AI and healthcare need each other, and the key data governance challenges involved in implementing AI in healthcare. The collected articles promise not only a good review of AI in healthcare but also a balanced perspective for readers as to what AI can do for healthcare.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41953813","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}